Improving uptake of screening for colorectal cancer (original) (raw)
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European journal of gastroenterology & hepatology, 2015
The aim of this study was to compare the uptake of mail-delivered tests for colorectal cancer screening. We assessed the effect of an advance notification letter and a reminder letter, and analysed the proportion of inappropriately handled tests. Fifteen thousand randomly selected residents of Latvia aged 50-74 years were allocated to receive one of three different test systems: either a guaiac faecal occult blood test (gFOBT) or one of two laboratory-based immunochemical tests (FIT) - FOB Gold or OC-Sensor. Half of the target population received an advance notification letter; all nonresponders were sent a reminder letter. The uptake of screening was 31.2% for the gFOBT, 44.7% for FOB Gold and 47.4% for the OC-Sensor (odds ratio 0.55; 95% confidence interval 0.51-0.60 for gFOBT vs. FOB Gold; odds ratio 0.90; 95% confidence interval 0.83-0.98 for FOB Gold vs. OC-Sensor). The uptake in the gFOBT group was improved by the advance notification letter (7.7%, P<0.0001). 30.9% returned...
Journal of the Canadian Association of Gastroenterology, 2019
Background Colorectal cancer (CRC) screening with guaiac fecal occult blood test (gFOBT) reduces CRC-related death. Average risk individuals should be recalled for screening with gFOBT every 2 years in order to maximize effectiveness. However, adherence with repeated testing is often suboptimal. Our aim was to evaluate whether adding a gFOBT kit to a mailed recall letter improves participation compared with a mailed recall letter alone, among previous responders to a mailed invitation. Methods We conducted a cluster randomized controlled trial, with the primary care provider as the unit of randomization. Eligible patients had completed a gFOBT and tested negative in an earlier pilot study and were now due for recall. The intervention group received a mailed CRC screening recall letter from their primary care provider plus a gFOBT kit (n = 431) while the control group received a mailed CRC screening mailed recall letter alone (n = 452). The primary outcome was the uptake of gFOBT or ...
International Journal of Cancer, 2014
Regular screening using guaiac fecal occult blood test (gFOBT) reduces mortality from colorectal cancer (CRC). The objective of this study was to determine whether the addition of a gFOBT kit to a second mailed invitation compared to a second mailed invitation alone increases CRC screening among eligible persons who did not respond to an initial mailed invitation. We conducted a cluster randomized controlled trial, with the physician as the unit of randomization. Participants were persons who had been invited but who had not responded to an invitation for CRC screening in an earlier pilot project. The intervention group received a mailed gFOBT kit and second mailed CRC screening invitation (n 5 2,008) while the control group received a second mailed CRC screening invitation alone (n 5 1,586). The primary outcome was the uptake of gFOBT within 6 months of the second mailing. We found that the uptake of gFOBT was more than twice as high in the intervention group (20.1%) compared to the control group (9.6%). The absolute difference between the two groups was 10.5% (95% CI: 7.5-13.4%, p 0.0001). In a subsequent adjusted analysis, participants in the intervention group were twice as likely to complete the test as those in the control group (OR 5 2.1; 95% CI: 1.6-2.6). These findings suggest that directly mailed gFOBT kits increase CRC screening participation among previous nonresponders to a mailed invitation and that approximately 10 gFOBT kits would have to be sent by mail in order to screen 1 additional person. (ClinicalTrials.gov: NCT01629004). Colorectal cancer (CRC) is the third most common cancer and the fourth leading cause of cancer-related death worldwide. 1 Death from CRC is preventable through screening and early detection; as such, it is an important cause of avoidable cancerrelated death. There are a variety of CRC screening tests, however, only guaiac fecal occult blood testing (gFOBT) 2-4 and
Cancer Prevention Research
Longitudinal adherence is a critical component of the efficacy of stool-based screening programs because they should be repeated every 1-2 years. Few data have been published on the uptake in multiple rounds of fecal occult blood test-based (FOBT) colorectal cancer (CRC) screening. We calculated two measures of longitudinal adherence to biennial FOBT (guaiac fecal occult blood test:gFOBT or fecal immunochemical test: FIT) to better understand its impact on the programmatic effectiveness of a population-based CRC screening program (2000-2017). Ongoing population-based CRC program of men and women aged 50-69 years. Variables: Age at first CRC screening invitation, sex, number of screening invitations, number of screens, deprivation score, and uptake rate. Logistic regression models were used to assess the independent effect of sex, age at first invitation, deprivation, and the type of screening test offered on adherence. The uptake rate for guaiac fecal occult blood test (gFOBT) was 23.9%, and for the fecal immunochemical test (FIT), it was 37.4%. The overall rate of consistently screened invitees after seven rounds of screening was 14.2%, being 20.6% for those individuals who used FIT and 14.3% for those who used gFOBT. Factors associated with continued participation (consistent vs. inconsistent screenees) showed that the longitudinal adherence was associated with age, screening test used, and number of invitations. Continued participation was lower in individuals who were screened using FIT than among those screened using gFOBT [OR, 0.68; 95% confidence interval (CI), 0.57-0.81]. The overall rate of consistently screened invitees for colorectal cancer screening was higher with FIT than gFOBT. Studying the rate of individuals being current for screening may help to anticipate potential benefits before the long-term outcome data are available.
Implementation science : IS, 2015
Timely follow-up of fecal occult blood screening with colonoscopy is essential for achieving colorectal cancer mortality reduction. This study evaluates the effectiveness of two ongoing interventions designed to improve colonoscopy uptake after a positive fecal occult blood test (FOBT) result within Ontario's population-wide ColonCancerCheck program. The first was a revision of mailed FOBT lab results to physicians to explicitly define a positive FOBT and to recommend colonoscopy. The second was a letter to participants informing them of the positive FOBT and urging them to seek appropriate follow-up. Prospective cohort study using Ontario's ColonCancerCheck program data sets (2008-2011), linked to provincial administrative health databases. Crude rate ratios were calculated to assess determinants of colonoscopy uptake among an Ontario-wide FOBT-positive cohort with rolling enrolment, followed from October 2008 through February 2011. Segmented time-series regression was used...
JNCI Journal of the National Cancer Institute, 2004
Background: Although colorectal cancer screening by using a fecal occult blood test (FOBT), flexible sigmoidoscopy, colonoscopy, or barium enema x-ray reduces the incidence of and death from colorectal cancer, the rate of colorectal cancer screening in the general population is low. We conducted a randomized trial consisting of direct mailing of FOBT kits to increase colorectal cancer screening among residents of Wright County, Minnesota, a community in which colorectal cancer screening was promoted. Methods: At baseline, we mailed a questionnaire about colorectal cancer screening to a random sample of Wright County residents aged 50 years or older who were randomly selected from the Minnesota State Driver's License and Identification Card database (estimated N ؍ 1451). The sample was randomly allocated into three equal subgroups: one group (control) received only the questionnaire, one group received FOBT kits by direct mail with reminders, and one group received FOBT kits by direct mail without reminders. Study participants were sent a follow-up questionnaire 1 year after baseline. We used the responses to the questionnaires to estimate the 1-year change in self-reported screening rates in each group and the differences in the changes among the groups, along with the associated bootstrap 95% confidence intervals (CIs). Results: At baseline, the estimated response rate was 86.5%, self-reported adherence to FOBT guidelines was 21.5%, and overall adherence to any colorectal cancer screening test guidelines was 55.8%. The 1-year rate changes in absolute percentage for self-reported adherence to FOBT use were 1.5% (95% CI ؍ -2.9% to 5.9%) for the control group, 16.9% (95% CI ؍ 11.5% to 22.3%) for the directmail-FOBT-with-no-reminders group, and 23.2% (95% CI ؍ 17.2% to 29.3%) for the direct-mail-FOBT-withreminders group. The 1-year rate changes for self-reported adherence to any colorectal cancer screening test were 7.8% (95% CI ؍ 3.2% to 12.0%) for the control group, 13.2% (95% CI ؍ 8.4% to 18.2%) for the direct-mail-FOBT-withno-reminders group, and 14.1% (95% CI ؍ 9.1% to 19.1%) for the direct-mail-FOBT-with-reminders group. Conclusion: Direct mailing of FOBT kits combined with follow-up reminders promotes more rapid increases in the use of FOBT and nearly doubles the increase in overall rate of adherence to colorectal cancer screening guidelines in a general population compared with a community-wide screening promotion and awareness campaign. [J Natl Cancer Inst 2004;96:770 -80]
Impact of stopping sending colorectal cancer screening test kits by regular mail
Public Health, 2019
Mailing of the screening test kit Participation rate Delay to perform the screening test a b s t r a c t Objective: From 2009 to 2013, the French colorectal cancer screening program (CRCSP) provided for a medical phase and a phase of systematic mailing of the test kit (SMTK) to people who could not participate in the medical phase. After 2013, the SMTK was abandoned in most districts. This study aims to analyze the impact of this termination. Study design: This was a descriptive and cohort study. Methods: The study concerned a cohort of 143,989 people (aged 50e74 years) living in Seine-Saint-Denis (France), invited to participate in the 2013 campaign (with SMTK) and in the 2015 campaign (without SMTK). The impact of SMTK termination was analyzed in terms of the difference between the participation rates and between the delay (expected vs observed) in performing the screening test in 2015. These differences were described based on previous solicitation in the CRCSP. Expected rates and expected delay were estimated in a Monte Carlo simulation. Results: The participation rate observed (20.0%) was higher than expected (16.1% [15.9 e16.3]). People who have never had a SMTK between 2007 and 2013 (80.0% [79.3e80.7] vs 69.6%) and those who participated in all campaigns before 2015 (97.0% [96.7e97.3] vs 82.6%) had an observed rate lower than expected. The delay observed (4.2 months) was longer than expected (2.5 months). Conclusion: The sudden termination certainly contributed to the extension of the delay. However, it did not have a major impact on the participation rate, partly due to information campaigns on the new screening test. In this cohort, the low participation would be explained better by the behavior in the previous campaigns than by the lack of SMTK.
Improving fecal occult blood testing compliance using a mailed educational reminder
Journal of general …, 2009
BACKGROUNDColorectal cancer (CRC) is one of the leading causes of cancer-related deaths in the United States. Randomized controlled trials have shown that annual screening fecal occult blood testing (FOBT) reduces CRC mortality and incidence. However, patient compliance with FOBT is low.OBJECTIVETo determine whether a mailed educational reminder increases FOBT card return rates and to examine predictors of FOBT compliance.DESIGNBlinded, randomized, controlled trial at the Veteran Affairs Medical Center, San Diego, California.PATIENTSSeven hundred and seventy-five consecutive patients ≥50 years of age referred by their primary care physicians for FOBT.INTERVENTIONPatients were randomly assigned to the usual care group or the intervention group. Ten days after picking up the FOBT cards, a 1-page reminder with information related to CRC screening was mailed to the intervention group only.MEASUREMENTSThe primary outcome was proportion of returned FOBT cards after 6 months. Patient demographic, clinical characteristics and prior FOBT completed were collected for multivariate regression analysis.RESULTSAt 6 months after card distribution, 64.6% of patients in the intervention group returned cards compared with 48.4% in the control group (P < 0.001). Patients who received a mailed reminder (OR 2.02; 95% CI: 1.48–2.74) or have a prior history of returning the FOBT cards (OR 1.87; 95% CI: 1.29–2.70) were more likely to return the FOBT cards. Patients with current or recent illicit drug use were less likely to return the FOBT cards (OR 0.26; 95% CI: 0.13–0.50).CONCLUSIONA simple mailed educational reminder significantly increases compliance with FOBT for CRC screening.Electronic supplementary materialThe online version of this article (doi:10.1007/s11606-009-1087-5) contains supplementary material, which is available to authorized users.
Cancer Prevention Research, 2019
Suboptimal participation is commonly observed in colorectal cancer screening programs utilizing fecal tests. This randomized controlled trial tested whether the offer of a blood test as either a “rescue” strategy for fecal test nonparticipants or an upfront choice, could improve participation. A total of 1,800 people (50–74 years) were randomized to control, rescue, or choice groups (n = 600/group). All were mailed a fecal immunochemical test (FIT, OC-Sensor, Eiken Chemical Company) and a survey assessing awareness of the screening tests. The rescue group was offered a blood test 12 weeks after FIT nonparticipation. The choice group was given the opportunity to choose to do a blood test (Colvera, Clinical Genomics) instead of FIT at baseline. Participation with any test after 24 weeks was not significantly different between groups (control, 37.8%; rescue, 36.9%; choice, 33.8%; P > 0.05). When the rescue strategy was offered after 12 weeks, an additional 6.5% participated with the...