Rolling-out Screening Volume Affecting Compliance Rate and Waiting Time of FIT-based Colonoscopy

Jen, Hsiao-Hsuan; Hsu, Chen Yang; Chen, Sam Li Sheng; Yen, Amy Ming Fang; Chiu, Sherry Yueh Hsia; Fann, Jean Ching Yuan; Lee, Yi–Chia; Wu, Ming Shiang; Hsu, Wen‐Feng; Peng, Szu Min; Chen, Chien-Jen; Chiu, Han–Mo

doi:10.1097/mcg.0000000000000955

Cited by 9 publications

(5 citation statements)

References 19 publications

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“…Delay of diagnostic colonoscopy may lead to increased likelihood of detecting a lesion at a more advanced or non‐curable stage. Rescheduling of or prolongation of waiting for colonoscopy is related with cancellation of colonoscopy, which may lead to more grave outcomes 25 . Our previous study has demonstrated that if people are not compliant to colonoscopy after positive FITs, then there was 60% higher risk of CRC death compared with those who were compliant 26 .…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID‐19 pandemic on fecal immunochemical test screening uptake and compliance to diagnostic colonoscopy

Cheng

Chen

et al. 2020

J of Gastro and Hepatol

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Background and Aim During this COVID‐19 pandemic, Taiwan is one of the few countries where fecal immunochemical test and endoscopic activity for colorectal cancer screening keeps ongoing. We aimed to investigate how screening uptake and colonoscopy rate were affected in one of the biggest screening hubs in Northern Taiwan. Methods We conducted a prospective observational study tracing and analyzing the screening uptake and the trend of compliance to diagnostic colonoscopy in fecal immunochemical test‐positive subjects in the National Taiwan University Hospital screening hub since the outbreak of COVID‐19 and compared it with that of the corresponding periods in the past 3 years. Cancellation and rescheduling rates of colonoscopy and related reasons were also explored. Results Screening uptake during December 2019 to April 2020 was 88.8%, which was significantly lower than that in the corresponding period of the past 3 years (91.2–92.7%, P for trend < 0.0001). Colonoscopy rate in this period was 66.1%, which was also significantly lower than that in the past 3 years (70.2–77.5%, P for trend = 0.017). Rescheduling or cancellation rate was up to 10.9%, which was significantly higher than that in the past 3 years ( P for trend = 0.023), and half of them was due to the fear of being infected. Conclusion Fecal immunochemical test screening was significantly affected by COVID‐19 pandemic. In order to resume the practice in COVID‐19 era, screening organizers should consider various approaches to secure timely diagnosis of colorectal cancer.

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Section: Discussionmentioning

confidence: 99%

Impact of COVID‐19 pandemic on fecal immunochemical test screening uptake and compliance to diagnostic colonoscopy

Cheng

Chen

et al. 2020

J of Gastro and Hepatol

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“…People from low-socioeconomic backgrounds are more likely to receive care in underresourced healthcare settings such as community health centers or have limited or no access to colonoscopy. [104][105][106] Colonoscopy detects adenomas with high levels of sensitivity (50%-95%), as well as CRC (75%-95% specificity), 107 and allows for evaluation of detected lesions at the time of screening, without the need for an additional test. The infrequent screening interval might be advantageous to patients from underserved backgrounds who have frequent changes in contact information and/or insurance.…”

Section: Community Resources and Community-based Interventionsmentioning

confidence: 99%

Causes of Socioeconomic Disparities in Colorectal Cancer and Intervention Framework and Strategies

2020

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Colorectal cancer (CRC) disproportionately affects people from low socioeconomic backgrounds and some racial minorities. Disparities in CRC incidence and outcomes might result from differences in exposure to risk factors such as unhealthy diet and sedentary lifestyle; limited access to risk-reducing behaviors such as chemoprevention, screening, and follow up of abnormal test results; or lack of access to high-quality treatment resources. These factors operate at the individual, provider, health system, community, and policy levels to perpetuate CRC disparities. However, CRC disparities can be eliminated. Addressing the complex factors that contribute to development and progression of CRC with multicomponent, adaptive interventions, at multiple levels of the care continuum, can reduce gaps in mortality. These might be addressed with a combination of healthcare and community-based interventions and policy changes that promote healthy behaviors and ensure access to high-quality and effective measures for CRC prevention, diagnosis, and treatment. Improving resources and coordinating efforts in communities where people of low-socioeconomic status live and work would increase access to evidence-based interventions. Research is also needed to understand the role and potential mechanisms by which factors in diet, intestinal microbiome, and/or inflammation contribute to differences in colorectal carcinogenesis. Studies of large cohorts with diverse populations are needed to identify epidemiologic and molecular factors that contribute to CRC development in different populations.

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“…Previous analyses of time-to-diagnosis primarily focused on FIT-positive patients, revealing that individuals who underwent colonoscopy more than 6 months after a FIT-positive result exhibited a notably elevated risk of advancedstage colorectal cancer. 29 The delay in diagnostic examination can be attributed to a variety of factors, including limited colonoscopy capacity following the expansion of FIT screenings after 2010, 30 lack of patient awareness about the significance of positive FIT results, limitations in healthcare services, extended waiting times that result in patient dropoff, and financial constraints that make examinations unaffordable for some individuals. 31 A recent study also assessed 14 However, it is important to emphasize that the study focused on individuals who had participated in screening previously, without distinguishing between different FIT results or evaluating whether follow-up examinations were conducted.…”

Section: Discussionmentioning

confidence: 99%

Screening History and 7-Year Survival in 32,099 Colorectal Cancer Patients: A Population-Based Cohort Study

Hsiao,

Chiang,

Yang

et al. 2023

CLEP

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Background It is unclear whether colorectal cancer screening history, regardless of stage, is an independent predictor of survival, and if the screening advantage persists after diagnosis. 32 099 patients with colorectal cancer were enrolled in this population-based cohort study. Methods We used data from the Taiwan Cancer Registry on patients with a first-time diagnosis of colorectal cancer between 2013 and 2015. In addition, we utilized data from a nationwide database of colorectal cancer screening programs to evaluate patients’ screening histories, and sourced outcome data from the National Death Registry, tracking patients up to the last day of 2019. Results Compared with fecal immunochemical testing (FIT)-positive patients with a follow-up examination, the adjusted hazard ratios (95% confidence intervals) for death from colorectal cancer were 1.40 (1.26–1.56) for FIT-positive patients without a follow-up examination, 1.63 (1.48–1.78) for FIT-negative patients, and 1.76 (1.65–1.89) for never screened patients. The adjusted hazard ratios for the FIT-positive patients with a follow-up examination increased when diagnosis was delayed by more than 12 months and were 1.2 after a 2-year delay. The adjusted hazard ratios for FIT-negative patients were approximately 2.0, decreased rapidly to 1.6, and stabilized after the 9th time-to-diagnosis month. Conclusion In colorectal cancer patients, screening history prior to diagnosis is an independent prognostic factor, regardless of cancer stage or other variables. This study recommends that physicians take screening history into account during diagnosis to optimize follow-up and management for patients at higher risk.

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Rolling-out Screening Volume Affecting Compliance Rate and Waiting Time of FIT-based Colonoscopy

Abstract: The decrease in compliance rate and an increase in the WT with variation across geography and institution resulting from the increased volume of rolling-out FIT screening provide an insight into optimal resource allocation of clinical capacity for colonoscopy.

Cited by 9 publications

References 19 publications

Impact of COVID‐19 pandemic on fecal immunochemical test screening uptake and compliance to diagnostic colonoscopy

Impact of COVID‐19 pandemic on fecal immunochemical test screening uptake and compliance to diagnostic colonoscopy

Causes of Socioeconomic Disparities in Colorectal Cancer and Intervention Framework and Strategies

Screening History and 7-Year Survival in 32,099 Colorectal Cancer Patients: A Population-Based Cohort Study

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