Adherence to colorectal cancer screening: four rounds of faecal immunochemical test-based screening

Vlugt, Manon van der; Grobbee, Esmée J.; Bossuyt, Patrick M.; Bongers, Evelien; Spijker, Wolfert; Kuipers, Ernst J.; Lansdorp–Vogelaar, Iris; Essink‐Bot, Marie‐Louise; Spaander, Manon C.W.; Dekker, Evelien

doi:10.1038/bjc.2016.399

Cited by 70 publications

(55 citation statements)

References 38 publications

(43 reference statements)

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“…The reported compliance rate varies tremendously between CRC screening programs worldwide (10-71%), depending on socioeconomic status, ethnicity, age, gender, psychological factors, and other factors [21]. Whereas newer CRC screening programs based on mailed fecal immunochemical tests and screening colonoscopy can reach a majority of patients in some settings [35,36], there is concern that fecal immunochemical tests may be less sensitive than colonoscopy for right-sided colorectal cancers [37]. Colonoscopy resources are also limited [38], and there is evidence of overuse of screening and surveillance colonoscopy in the USA [31,32], which may reduce access for others with higher risk of CRC.…”

Section: Discussionmentioning

confidence: 99%

Early Colorectal Cancer Detected by Machine Learning Model Using Gender, Age, and Complete Blood Count Data

Hornbrook

Goshen²,

Choman³

et al. 2017

Dig Dis Sci

100

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Background Machine learning tools identify patients with blood counts indicating greater likelihood of colorectal cancer and warranting colonoscopy referral. Aims To validate a machine learning colorectal cancer detection model on a US community-based insured adult population. Methods Eligible colorectal cancer cases (439 females, 461 males) with complete blood counts before diagnosis were identified from Kaiser Permanente Northwest Region's Tumor Registry. Control patients (n = 9108) were randomly selected from KPNW's population who had no cancers, received at C1 blood count, had continuous enrollment from 180 days prior to the blood count through 24 months after the count, and were aged 40-89. For each control, one blood count was randomly selected as the pseudo-colorectal cancer diagnosis date for matching to cases, and assigned a ''calendar year'' based on the count date. For each calendar year, 18 controls were randomly selected to match the general enrollment's 10-year age groups and lengths of continuous enrollment. Prediction performance was evaluated by area under the curve, specificity, and odds ratios. Results Area under the receiver operating characteristics curve for detecting colorectal cancer was 0.80 ± 0.01. At 99% specificity, the odds ratio for association of a high-risk detection score with colorectal cancer was 34.7 (95% CI 28.9-40.4). The detection model had the highest accuracy in identifying right-sided colorectal cancers. Conclusions ColonFlag Ò identifies individuals with tenfold higher risk of undiagnosed colorectal cancer at curable stages (0/I/II), flags colorectal tumors 180-360 days prior to usual clinical diagnosis, and is more accurate at identifying right-sided (compared to left-sided) colorectal cancers.

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Section: Discussionmentioning

confidence: 99%

Early Colorectal Cancer Detected by Machine Learning Model Using Gender, Age, and Complete Blood Count Data

Hornbrook

Goshen²,

Choman³

et al. 2017

Dig Dis Sci

100

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“…14 In the Netherlands, among 23,339 participants, adherence to 3 rounds of biennial fecal immunochemical testing ranged from 60% to 63%, with 72% participating at least once and 48% participating in all rounds. 15 Fewer populationbased data are available for colonoscopy adherence. In the Nordic-European Initiative on Colorectal Cancer Study, of 31,420 participants randomized to colonoscopy screening, 40% completed testing.…”

Section: Discussionmentioning

confidence: 99%

“…Information on longer term adherence to mailed fecal-testing programs comes from organized programs, but these studies lack a comparison group. [12][13][14][15] Systems of Support to Increase Colorectal Cancer Screening and Follow-Up (SOS) is an ongoing trial that, between 2008 and 2009, randomized age-eligible patients not current for CRC screening to either the usual care (UC) or 1 of 3 stepped-intensity interventions: mailings (including mailed fecal tests), mailings plus brief telephone assistance, or mailings and assistance plus nurse navigation. 16 The UC group had access to clinic-based screening strategies but no organized program for mailing fecal tests.…”

Section: Introductionmentioning

confidence: 99%

A centralized mailed program with stepped increases of support increases time in compliance with colorectal cancer screening guidelines over 5 years: A randomized trial

Green

Anderson

Cook

et al. 2017

Cancer

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Background Screening over many years is required to optimize reductions in colorectal cancer (CRC) mortality. However, no prior trials have tested methods for obtaining long-term adherence. Methods Systems of Support to Increase Colorectal Cancer Screening and Follow-Up (SOS) was implemented in an integrated healthcare organization in Washington State. Between 2008 and 2009, 4675 individuals aged 50–74 were randomized to receive: (Arm 1) Usual care (UC), which included clinic-based strategies to increase CRC screening, or in years 1 and 2: (Arm 2) Mailings with a call-in number for colonoscopy and mailed fecal tests; (Arm 3) Mailings plus brief telephone assistance; or (Arm 4) Mailings and assistance plus nurse navigation. Active intervention subjects (Arms 2, 3, and 4 combined) still eligible for CRC screening were randomized to stopped or continued mailings in years 3 and 5. We compared time in compliance with CRC screening over five years in persons assigned to any intervention versus usual care. Screening tests contributed time based on national guidelines for screening intervals (fecal tests annually, sigmoidoscopy 5-years, colonoscopy 10-years). Results All participants contributed data, but were censored at disenrollment, death, age 76, or CRC diagnosis. Compared to UC, intervention participants had 31% more adjusted covered-time over 5 years (Incidence Rate Ratio 1.31 [1.25–1.37], 47.5% vs. 62.1% covered-time). Fecal testing accounted for almost all additional covered-time. Conclusions In a healthcare organization with clinic-based activities to increase CRC screening, a centralized program led to increased CRC screening adherence over 5 years. Longer-term data on screening adherence and its impact on CRC outcomes are needed.

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“…In Scotland, among 251,578 eligible adults, adherence of 55%, 45%, and 48% in years 1, 2, and 3, respectively, were reported [7]. In the Netherlands, among 23,339 participants, adherence to 3 rounds of biennial FIT ranged from 60% to 63%, with 72% participating at least once and 48% participating in all rounds [8].…”

Section: Introductionmentioning

confidence: 99%

Reasons for Never and Intermittent Completion of Colorectal Cancer Screening After Receiving Multiple Rounds of Mailed Fecal Tests

Green¹,

BlueSpruce²,

Tuzzio³

et al. 2017

Journal of Patient-Centered Research and Reviews

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Background: Long-term adherence to colorectal cancer (CRC) screening is particularly important for fecal testing. Some U.S. studies report that only 25% of individuals repeat fecal testing annually. The purpose of this qualitative study was to identify barriers and facilitators reported by patients with suboptimal screening adherence to refine interventions for starting ongoing adherence to CRC screening. We also explored whether participants, particularly never screeners, would be willing to do a CRC screening blood test. Methods: Forty-one patients who previously enrolled in the Systems of Support to Increase CRC Screening (SOS) trial were interviewed 4-5 years later. Participants were purposively selected to include men and women with diverse race/ethnicities who had either been inconsistent screeners or had never screened during the first three years of SOS despite receiving at least two rounds of mailed fecal tests. Two interviewers conducted 30-min telephone interviews using a semi-structured interview guide. An iterative thematic analysis approach was used. Results: Themes related to screening barriers were more pervasive among never screeners including: (1) Avoidance (inattention, procrastination) (2) Concerns about handling stool; (3) Health concerns; (4) Fear of a cancer diagnosis or positive test results. Themes related to screening facilitators were more often mentioned by participants who screened at least once including: (1) Use of a simpler 1-sample fecal test; (2) Convenience of mailings and doing the test at home; (3) Salience of prevention, especially as one got older; and (4) Influence of recommendations from providers, family and friends. Participants had diverse preferences for the number (3 on average) and types (phone, mail, text) of screening reminders. Some participants did not prefer e-mail links to the patient shared electronic health record because of difficulties remembering their password. It was acceptable for a nurse or medical assistant not from their clinic to call them as long as that person was knowledgeable about their records and could communicate with their physician. Participants, especially never screeners, were generally very enthusiastic about the potential option of a CRC screening blood test.

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Adherence to colorectal cancer screening: four rounds of faecal immunochemical test-based screening

Cited by 70 publications

References 38 publications

Early Colorectal Cancer Detected by Machine Learning Model Using Gender, Age, and Complete Blood Count Data

Early Colorectal Cancer Detected by Machine Learning Model Using Gender, Age, and Complete Blood Count Data

A centralized mailed program with stepped increases of support increases time in compliance with colorectal cancer screening guidelines over 5 years: A randomized trial

Reasons for Never and Intermittent Completion of Colorectal Cancer Screening After Receiving Multiple Rounds of Mailed Fecal Tests

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