medwireNews: Outreach interventions directed at individuals or physicians can improve the uptake and completion of colorectal cancer (CRC) screening, indicate two trials published in JAMA.
In the first study, 5999 participants aged 50–64 years who were not up-to-date with CRC screenings were randomly assigned to receive either colonoscopy or fecal immunochemical test (FIT) outreach, both of which involved a mailed invitation and reminder calls, or usual care. In the case of the FIT outreach, individuals were also sent a home test kit, and the colonoscopy intervention included scheduling assistance.
The screening process was completed within 3 years by 38.4% of the colonoscopy outreach group, who underwent one procedure, and by 28.0% of the FIT outreach group, who either completed three annual screenings with a negative result or underwent diagnostic colonoscopy after an abnormal result. By comparison only 10.7% of those in the usual care group completed screening.
The between-group differences were significant in favor of either outreach group when compared to the usual care group and also for the colonoscopy versus FIT outreach group, report Amit Singal (University of Texas Southwestern, Dallas, USA) and colleagues.
They note, however, that “screening process completion for both outreach groups remained below 40%, highlighting the potential for further improvement.”
The second study, conducted by Cédric Rat (Faculty of Medicine of Nantes, France) and co-workers, evaluated the effect of a physician-based intervention on patient participation in CRC screening.
A total of 1446 general practitioners (GPs) from 801 practices in two regions on the French west coast were randomly assigned to either receive a list of patients overdue for screening, information on region-specific CRC screening adherence, or no information. Patients were eligible for the study if they were aged between 50 and 74 years, had an average risk for CRC, and were not up-to-date with screening.
Of the 10,476 individuals assigned to GPs in the patient-specific reminders group, an average of 24.8% participated in FIT screening by the 1-year mark. This was significantly higher than the mean rates of 21.7% and 20.6% for the 10,606 and 10,147 individuals seen by GPs in the generic reminder and usual care groups, respectively.
However, the use of generic reminders did not increase screening uptake over usual care.
Rat et al comment that the absolute increase in the participation rate of 4.2% in the patient-specific reminder versus usual care groups is “modest” and “might be regarded as disappointing.”
But they believe that “the observed effects might continue to increase if patient-specific reminders were implemented in usual care.”
Writing in a linked editorial, Michael Pignone (University of Texas, Austin, USA) and David Miller (Wake Forest School of Medicine, Winston-Salem, North Carolina, USA) say that creative methods are needed to improve the currently inadequate rates of CRC screening in the USA.
They write: “If sufficient resources are in place, outreach efforts should be implemented with a choice of FIT or colonoscopy-based screening, followed by sufficient support, including patient navigation, to ensure high levels of adherence to patients’ chosen strategies.”
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