Mailed FIT outreach increases CRC screening rates among diverse, low-income patients in US
Key takeaways:
- Patients who received mailed outreach had a higher rate of screening completion at 6 months vs. those who received usual care.
- More patients in the intervention group also underwent follow-up colonoscopy.
A centralized colorectal cancer screening intervention boosted fecal immunochemical test completion, as well as follow-up colonoscopy, among average-risk individuals served by federally qualified health centers, according to research.
“Despite compelling evidence that CRC screening reduces CRC mortality, screening is severely underused in federally qualified health centers (FQHCs), which serve more than 30 million low-income individuals in the U.S.,” Daniel S. Reuland, MD, MPH, program director of the Carolina Cancer Screening Initiative at UNC Lineberger Comprehensive Cancer Center, and colleagues wrote in JAMA Network Open. “Accumulating evidence supports intervention strategies including organized mailed FIT outreach directly to individuals to improve screening.”
In a pragmatic randomized clinical trial, Reuland and colleagues investigated the effectiveness of a centralized, multilevel screening intervention among 4,002 patients (mean age, 59.6 years; 56.4% women; 57.2% non-Hispanic white) at average risk for CRC and due for screening at two FQHCs in rural North Carolina.
Patients in the intervention arm (n = 2,001) received mailed FIT screening materials with reminders and an invitation for follow-up colonoscopy upon positive results, while those in the control arm (n = 2,001) received usual care alone.
The primary outcome was completion of CRC screening within 6 months; secondary outcomes were colonoscopy completion within 6 months of positive FIT result and detection of advanced colorectal neoplasia.
Researchers noted 24% of patients were uninsured at baseline, while 29.9% had commercial insurance, 15.4% had Medicaid and 30.7% had Medicare.
According to study results, patients in the intervention arm had a higher rate of screening completion at 6 months (30% vs. 9.7%; difference = 20.29 percentage points; 95% CI, 17.85-22.73) and 12 months (34.6% vs. 16.6%; difference = 17.99 percentage points; 95% CI, 15.3-20.69) following randomization, with “no statistically significant differences” in the effectiveness of intervention when stratified by insurance type.
FIT yielded positive results among 8.7% of patients in the intervention arm and 13.4% of controls, of whom 68.8% and 44.4%, respectively, underwent follow-up colonoscopy within 6 months (difference = 24.3 percentage points; 95% CI, –2.13 to 50.74).
Further results demonstrated the presence of advanced colorectal neoplasia among 1.4% vs. 0.7% (difference = 0.68 percentage points; 95% CI, 0.05-1.35).
“Centralized mailed FIT outreach intervention and patient navigation effectively increased CRC screening among diverse populations served by independent FQHCs,” Reuland and colleagues wrote. “The intervention was effective across all insurance categories and was associated with increased detection of advanced colorectal neoplasia.”
They continued, “Future work will examine cost issues that can inform policy decision-making regarding spread and sustainment with payers and other entities that may be able to provide similar types of centralized support, such as state community health center associations or cancer centers.”
Collapse