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Showing content from https://pubmed.ncbi.nlm.nih.gov/33452083/ below:

Barriers to Follow-Up Colonoscopy After Positive FIT or Multitarget Stool DNA Testing

Affiliations

• ¹ From the Division of Gastroenterology, University Hospitals Cleveland Medical Center, Cleveland OH (GSC, AG); Center for Community Health Integration and Department of Family Medicine, Case Western Reserve University, Cleveland OH (JW, KCS); Department of Population and Quantitative Health, Case Western Reserve University, Cleveland OH (SC, PF); and the Case Comprehensive Cancer Center, Cleveland OH (GSC, JW, PF, KCS). gregory.cooper@uhhospitals.org.
• ² From the Division of Gastroenterology, University Hospitals Cleveland Medical Center, Cleveland OH (GSC, AG); Center for Community Health Integration and Department of Family Medicine, Case Western Reserve University, Cleveland OH (JW, KCS); Department of Population and Quantitative Health, Case Western Reserve University, Cleveland OH (SC, PF); and the Case Comprehensive Cancer Center, Cleveland OH (GSC, JW, PF, KCS).

• PMID: 33452083
• DOI: 10.3122/jabfm.2021.01.200345

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Gregory S Cooper et al. J Am Board Fam Med. 2021 Jan-Feb.

• ¹ From the Division of Gastroenterology, University Hospitals Cleveland Medical Center, Cleveland OH (GSC, AG); Center for Community Health Integration and Department of Family Medicine, Case Western Reserve University, Cleveland OH (JW, KCS); Department of Population and Quantitative Health, Case Western Reserve University, Cleveland OH (SC, PF); and the Case Comprehensive Cancer Center, Cleveland OH (GSC, JW, PF, KCS). gregory.cooper@uhhospitals.org.
• ² From the Division of Gastroenterology, University Hospitals Cleveland Medical Center, Cleveland OH (GSC, AG); Center for Community Health Integration and Department of Family Medicine, Case Western Reserve University, Cleveland OH (JW, KCS); Department of Population and Quantitative Health, Case Western Reserve University, Cleveland OH (SC, PF); and the Case Comprehensive Cancer Center, Cleveland OH (GSC, JW, PF, KCS).

• PMID: 33452083
• DOI: 10.3122/jabfm.2021.01.200345

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Background: Fecal immunochemical testing (FIT) and multi-target stool DNA testing (mt-sDNA) are recommended colorectal cancer screening options but require follow-up with colonoscopy to determine the source of a positive result. We performed a retrospective analysis in an academic health system to determine adherence to colonoscopy in these patients.

Methods: We identified all patients aged 40 years and older with at least 1 primary care visit who had a positive FIT or mt-sDNA between January 2016 and June 2018. We identified receipt of colonoscopy within 6 months of the positive test and reviewed medical records to determine reasons for lack of colonoscopy.

Results: We identified 308 eligible patients with positive FIT and 323 with positive mt-sDNA. Some patients with positive FIT (46.7%) and patients with positive mt-sDNA (71.5%) underwent colonoscopy within 6 months, and time to colonoscopy was also shorter with mt-sDNA (hazard ratio, 1.83; 95% CI, 1.48-2.25). These differences remained in a multivariable model adjusting for patient characteristics. Among patients without colonoscopy after positive FIT, 1 or more system, provider, and patient-related barriers were identified in 32.1%, 57.6%, and 36.3%, respectively. Among patients without colonoscopy after positive mt-sDNA, corresponding frequencies were 30.4%, 43.5%, and 57.6%, respectively.

Conclusions: Follow-up colonoscopy was higher for mt-sDNA than FIT, which could be due in part to preselection by clinicians and/or patients. Among patients who did not follow-up, provider and system factors were as frequently encountered as patient factors. These findings reinforce the need for multi-level interventions to improve follow-up.

Keywords: Cancer Screening; Colonoscopy; Colorectal Cancer; Mass Screening; Occult Blood.

© Copyright 2021 by the American Board of Family Medicine.

PubMed Disclaimer

Conflict of interest: None.

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