TY - JOUR
T1 - Outreach invitations for FIT and colonoscopy improve colorectal cancer screening rates
T2 - A randomized controlled trial in a safety-net health system
AU - Singal, Amit G.
AU - Gupta, Samir
AU - Tiro, Jasmin A.
AU - Skinner, Celette Sugg
AU - Mccallister, Katharine
AU - Sanders, Joanne M.
AU - Bishop, Wendy Pechero
AU - Agrawal, Deepak
AU - Mayorga, Christian A.
AU - Ahn, Chul
AU - Loewen, Adam C.
AU - Santini, Noel O.
AU - Halm, Ethan A.
N1 - Funding Information:
We thank the Polymedco Corporation for providing the fecal immunochemical test kits and reagents, Parkland Health and Hospital System faculty and staff for guidance and support of this trial, and the research team from the University of Texas Southwestern Medical Center for assistance in delivering outreach activities. The current study was conducted as part of the National Cancer Institute (NCI)-funded consortium Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) with support from National Institutes of Health (NIH)/NCI grant U54CA163308-01, NIH grant UL1TR001105, and NIH/NCI Cancer Center Support Grant P30 CA142543. Ethan A. Halm was supported in part by the Agency for Healthcare Research and Quality Center for Patient-Centered Outcomes Research (grant R24 HS022418). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Agency for Healthcare Research and Quality. Polymedco Corporation provided the fecal immunochemical test kits and reagents. Samir Gupta has acted as a paid member of the Scientific Advisory Board for Exact Sciences for work performed outside of the current study.
Publisher Copyright:
© 2015 American Cancer Society.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - BACKGROUND The effectiveness of colorectal cancer (CRC) screening is limited by underuse, particularly among underserved populations. Among a racially diverse and socioeconomically disadvantaged cohort of patients, the authors compared the effectiveness of fecal immunochemical test (FIT) outreach and colonoscopy outreach to increase screening participation rates, compared with usual visit-based care. METHODS Patients aged 50 to 64 years who were not up-to-date with CRC screening but used primary care services in a large safety-net health system were randomly assigned to mailed FIT outreach (2400 patients), mailed colonoscopy outreach (2400 patients), or usual care with opportunistic visit-based screening (1199 patients). Patients who did not respond to outreach invitations within 2 weeks received follow-up telephone reminders. The primary outcome was CRC screening completion within 12 months after randomization. RESULTS Baseline patient characteristics across the 3 groups were similar. Using intention-to-screen analysis, screening participation rates were higher for FIT outreach (58.8%) and colonoscopy outreach (42.4%) than usual care (29.6%) (P <.001 for both). Screening participation with FIT outreach was higher than that for colonoscopy outreach (P <.001). Among responders, FIT outreach had a higher percentage of patients who responded before reminders (59.0% vs 29.7%; P <.001). Nearly one-half of patients in the colonoscopy outreach group crossed over to complete FIT via usual care, whereas <5% of patients in the FIT outreach group underwent usual-care colonoscopy. CONCLUSIONS Mailed outreach invitations appear to significantly increase CRC screening rates among underserved populations. In the current study, FIT-based outreach was found to be more effective than colonoscopy-based outreach to increase 1-time screening participation. Studies with longer follow-up are needed to compare the effectiveness of outreach strategies for promoting completion of the entire screening process. Cancer 2016;122:456-463.
AB - BACKGROUND The effectiveness of colorectal cancer (CRC) screening is limited by underuse, particularly among underserved populations. Among a racially diverse and socioeconomically disadvantaged cohort of patients, the authors compared the effectiveness of fecal immunochemical test (FIT) outreach and colonoscopy outreach to increase screening participation rates, compared with usual visit-based care. METHODS Patients aged 50 to 64 years who were not up-to-date with CRC screening but used primary care services in a large safety-net health system were randomly assigned to mailed FIT outreach (2400 patients), mailed colonoscopy outreach (2400 patients), or usual care with opportunistic visit-based screening (1199 patients). Patients who did not respond to outreach invitations within 2 weeks received follow-up telephone reminders. The primary outcome was CRC screening completion within 12 months after randomization. RESULTS Baseline patient characteristics across the 3 groups were similar. Using intention-to-screen analysis, screening participation rates were higher for FIT outreach (58.8%) and colonoscopy outreach (42.4%) than usual care (29.6%) (P <.001 for both). Screening participation with FIT outreach was higher than that for colonoscopy outreach (P <.001). Among responders, FIT outreach had a higher percentage of patients who responded before reminders (59.0% vs 29.7%; P <.001). Nearly one-half of patients in the colonoscopy outreach group crossed over to complete FIT via usual care, whereas <5% of patients in the FIT outreach group underwent usual-care colonoscopy. CONCLUSIONS Mailed outreach invitations appear to significantly increase CRC screening rates among underserved populations. In the current study, FIT-based outreach was found to be more effective than colonoscopy-based outreach to increase 1-time screening participation. Studies with longer follow-up are needed to compare the effectiveness of outreach strategies for promoting completion of the entire screening process. Cancer 2016;122:456-463.
KW - colonoscopy
KW - colorectal cancer screening
KW - fecal immunochemical test
KW - navigation
KW - randomized controlled trial
KW - safety-net health system
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U2 - 10.1002/cncr.29770
DO - 10.1002/cncr.29770
M3 - Article
C2 - 26535565
AN - SCOPUS:84949292754
SN - 0008-543X
VL - 122
SP - 456
EP - 463
JO - Cancer
JF - Cancer
IS - 3
ER -