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Omelu N, Kempster M, Velasquez L, Nunez de Ybarra J, Littaua R, Davis-Patterson S, Coelho M, Darsie B, Hunter J, Donahue C, Carrillo S, Arias R, Pinal S. Examining the Sustainability of Core Capacity and Evidence-Based Interventions for FIT-Based CRC Screening: California Colorectal Cancer Control Program. Cancer Control 2024; 31:10732748241255218. [PMID: 39058902 PMCID: PMC11282556 DOI: 10.1177/10732748241255218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 03/29/2024] [Accepted: 04/30/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVES We examined the extent to which funded satellite clinics could sustain the California Colon Cancer Control Program (C4P) strategies implemented in health systems to increase uptake of the fecal immunochemical test (FIT) or immunochemical fecal occult blood test (iFOBT) for colorectal cancer (CRC) screening in the absence of future C4P funds. INTRODUCTION Seven health systems consisting of 38 satellite clinics participated in C4P to examine the sustainability of the program in the absence future Centers for Disease Control and Prevention (CDC) funding. METHODS Quantitative and qualitative methods with a close and open-ended survey approach, and a prospective cohort design were used to examine the sustainability of the C4P in health systems. RESULTS A total of 61% of satellite clinics could not sustain funding stability. Only 26% could sustain funding stability. About, 71%, 26%, and 21% of the satellite clinics could sustain the small media platform, patient navigation services, and community health workers (CHWs), respectively. All the satellite clinics sustained the provider reminder system and professional development. Roughly, 71% and 42% of funded satellite clinics could not sustain the patient navigators and CHWs, respectively. The satellite clinics that could sustain funding stability, sustained patient navigation services and CHWs. Health systems that could not sustain funding stability, could not sustain patient navigation services and CHWs. Qualitatively, the need to support uninsured priority populations, health educators, patient navigators, care coordination activities, outreach services, and provision of enhanced services emerged. The need to support enhanced quality measures, expansion of funding, Medi-Cal Public Hospital Redesign and Incentive coverage, health plan, community linkages, resource sharing, and best practices specifically on CRC screening emerged. Themes such as automated reminder, limited personalized care delivery and capacity, transportation barriers, staff salary, expansion of care through patient navigation, and culturally appropriate media campaign also emerged. CONCLUSION Overall, to address sustainability barriers, funding stability should be maintained in the health systems.
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Affiliation(s)
- Ndukaku Omelu
- California Department of Public Health, Sacramento, CA, USA
| | | | | | | | - Renato Littaua
- California Department of Public Health, Sacramento, CA, USA
| | | | - Marco Coelho
- California Department of Public Health, Sacramento, CA, USA
| | - Brendan Darsie
- California Department of Public Health, Sacramento, CA, USA
| | - June Hunter
- American Cancer Society, Sacramento, CA, USA
| | | | | | | | - Sonia Pinal
- American Cancer Society, Sacramento, CA, USA
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Sullivan BA, Qin X, Redding TS, Weiss D, Upchurch J, Sims KJ, Dominitz JA, Stone A, Ear B, Williams CD, Lieberman DA, Hauser ER. Colorectal Cancer Polygenic Risk Score Is Associated With Screening Colonoscopy Findings but Not Follow-Up Outcomes. GASTRO HEP ADVANCES 2023; 3:151-161. [PMID: 39129957 PMCID: PMC11307447 DOI: 10.1016/j.gastha.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/03/2023] [Indexed: 08/13/2024]
Abstract
Background and Aims Colorectal cancer (CRC) polygenic risk scores (PRS) may help personalize CRC prevention strategies. We investigated whether an existing PRS was associated with advanced neoplasia (AN) in a population undergoing screening and follow-up colonoscopy. Methods We evaluated 10-year outcomes in the Cooperative Studies Program #380 screening colonoscopy cohort, which includes a biorepository of selected individuals with baseline AN (defined as CRC or adenoma ≥10 mm or villous histology, or high-grade dysplasia) and matched individuals without AN. A PRS was constructed from 136 prespecified CRC-risk single nucleotide polymorphisms. Multivariate logistic regression was used to evaluate the PRS for associations with AN prevalence at baseline screening colonoscopy or incident AN in participants with at least one follow-up colonoscopy. Results The PRS was associated with AN risk at baseline screening colonoscopy (P = .004). Participants in the lowest PRS quintile had more than a 70% decreased risk of AN at baseline (odds ratio 0.29, 95% confidence interval 0.14-0.58; P < .001) compared to participants with a PRS in the middle quintile. Using a PRS cut-off of more than the first quintile to indicate need for colonoscopy as primary screening, the sensitivity for detecting AN at baseline is 91.8%. We did not observe a relationship between the PRS and incident AN during follow-up (P = .28). Conclusion A PRS could identify individuals at low risk for prevalent AN. Ongoing work will determine whether this PRS can identify a subset of individuals at sufficiently low risk who could safely delay or be reassured about noninvasive screening. Otherwise, more research is needed to augment these genetic tools to predict incident AN during long-term follow-up.
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Affiliation(s)
- Brian A. Sullivan
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
- Division of Gastroenterology, Duke University, Durham, North Carolina
| | - Xuejun Qin
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
- Division of Gastroenterology, Duke University, Durham, North Carolina
| | - Thomas S. Redding
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
| | - David Weiss
- Cooperative Studies Program Coordinating Center, Perry Point VA Medical Center, Perry Point, Maryland
| | - Julie Upchurch
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
| | - Kellie J. Sims
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
| | - Jason A. Dominitz
- Division of Gastroenterology, VA Puget Sound Health Care System, Seattle, Washington
- Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington
| | - Anjanette Stone
- Cooperative Studies Program Pharmacogenomics Analysis Laboratory, Central Arkansas Veterans Health System, Little Rock, Arkansas
| | - Belinda Ear
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
| | - Christina D. Williams
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
- Division of Gastroenterology, Duke University, Durham, North Carolina
| | - David A. Lieberman
- Division of Gastroenterology, VA Portland Health Care System, Portland, Oregon
- Division of Gastroenterology, Oregon Health & Science University, Portland, Oregon
| | - Elizabeth R. Hauser
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
- Division of Gastroenterology, Duke University, Durham, North Carolina
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Zhan FB, Liu Y, Yang M, Kluz N, Olmstead TA, Spencer J, Shokar NK, Cruz RL, Pignone MP. Using GIS to Identify Priority Sites for Colorectal Cancer Screening Programs in Texas Health Centers. Prev Chronic Dis 2023; 20:E10. [PMID: 36862605 PMCID: PMC9983600 DOI: 10.5888/pcd20.220205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Affiliation(s)
- F Benjamin Zhan
- Texas Center for Geographic Information Science, Department of Geography and Environmental Studies, Texas State University, San Marcos, TX 78666 .,Cancer Prevention and Control Program, LiveStrong Cancer Institutes, Dell Medical School, University of Texas at Austin.,Department of Population Health, Dell Medical School, University of Texas at Austin
| | - Yanyan Liu
- Texas Center for Geographic Information Science, Department of Geography and Environmental Studies, Texas State University, San Marcos, Texas
| | - Mei Yang
- Texas Center for Geographic Information Science, Department of Geography and Environmental Studies, Texas State University, San Marcos, Texas
| | - Nicole Kluz
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin
| | - Todd A Olmstead
- University of Texas at Austin, LBJ School of Public Affairs, Austin, Texas
| | - Jenny Spencer
- Department of Population Health, Dell Medical School, University of Texas at Austin.,Department of Internal Medicine, Dell Medical School, University of Texas at Austin
| | - Navkiran K Shokar
- Cancer Prevention and Control Program, LiveStrong Cancer Institutes, Dell Medical School, University of Texas at Austin.,Department of Population Health, Dell Medical School, University of Texas at Austin
| | - Roxana L Cruz
- Texas Association of Community Health Centers, Austin, Texas
| | - Michael P Pignone
- Cancer Prevention and Control Program, LiveStrong Cancer Institutes, Dell Medical School, University of Texas at Austin.,Department of Population Health, Dell Medical School, University of Texas at Austin.,Department of Internal Medicine, Dell Medical School, University of Texas at Austin
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Pettit N, Sarmiento E, Kline J. Disparities in outcomes among patients diagnosed with cancer in proximity to an emergency department visit. Sci Rep 2022; 12:10667. [PMID: 35739143 PMCID: PMC9226041 DOI: 10.1038/s41598-022-13422-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/24/2022] [Indexed: 01/22/2023] Open
Abstract
A suspected diagnosis of cancer in the emergency department (ED) may be associated with poor outcomes, related to health disparities, however data are limited. This is a retrospective observational cohort of the Indiana State Department of Health Cancer Registry, and the Indiana Network for Patient Care. First time cancer diagnoses appearing in the registry between January 2013 and December 2017 were included. Cases identified as patients who had an ED visit in the 6 months before their cancer diagnosis; controls had no preceding ED visits. The primary outcome was mortality, comparing ED-associated mortality to non-ED-associated. 134,761 first-time cancer patients were identified, including 15,432 (11.5%) cases. The mean age was same at 65, more of the cases were Black than the controls (12.4% vs 7.4%, P < .0001) and more were low income (36.4%. vs 29.3%). The top 3 ED-associated cancer diagnoses were lung (18.4%), breast (8.9%), and colorectal cancers (8.9%), whereas the controls were breast (17%), lung (14.9%), and prostate cancers (10.1%). Cases observed an over three-fold higher mortality, with cumulative death rate of 32.9% for cases vs 9.0% for controls (P < .0001). Regression analysis predicting mortality, controlling for many confounders produced an odds ratio of 4.12 (95% CI 3.72-4.56 for cases). This study found that an ED visit within 6 months prior to the first time of ICD-coded cancer is associated with Black race, low income and an overall three-fold increased adjusted risk of death. The mortality rates for ED-associated cancers are uniformly worse for all cancer types. These data suggest that additional work is needed to reduce disparities among ED-associated cancer diagnoses.
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Affiliation(s)
- Nicholas Pettit
- Department of Emergency Medicine, Indiana University, Indianapolis, IN, USA.
| | - Elisa Sarmiento
- Department of Emergency Medicine, Indiana University, Indianapolis, IN, USA
| | - Jeffrey Kline
- Department of Emergency Medicine, Indiana University, Indianapolis, IN, USA. .,Department of Emergency Medicine, Wayne State University, 4201 St. Antoine, University Health Center - 6G, Detroit, MI, 48201, USA.
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5
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Luque JS, Vargas M, Wallace K, Matthew OO, Tawk R, Ali AA, Kiros GE, Harris CM, Gwede CK. Engaging the Community on Colorectal Cancer Screening Education: Focus Group Discussions Among African Americans. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:251-262. [PMID: 33904120 PMCID: PMC8075366 DOI: 10.1007/s13187-021-02019-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 05/18/2023]
Abstract
Colorectal cancer (CRC) is the third most diagnosed cancer in the USA, and African Americans experience disproportionate CRC diagnosis and mortality. Early detection could reduce CRC incidence and mortality, and reduce CRC health disparities, which may be due in part to lower screening adherence and later stage diagnosis among African Americans compared to whites. Culturally tailored interventions to increase access to and uptake of CRC stool-based tests are one effective strategy to increase benefits of screening among African Americans. The objectives of this study were to obtain feedback from African Americans on CRC educational materials being developed for a subsequent behavioral clinical trial and explore participants' knowledge, attitudes, and beliefs about CRC and CRC screening. Seven focus groups were conducted between February and November 2020. Participants were African Americans recruited through community contacts. Four focus groups were held in-person and three were conducted virtually due to Covid-19 restrictions. Participants ranked CRC educational text messages and provided feedback on a culturally tailored educational brochure. A focus group guide with scripted probes was used to elicit discussion and transcripts were analyzed using traditional content analysis. Forty-two African Americans participated. Four themes were identified from focus group discussions: (1) knowledge, attitudes, and beliefs on CRC and CRC screening; (2) reliable sources of cancer education information; (3) cultural factors affecting perspectives on health; and (4) community insights into cancer education. Participant input on the brochure was incorporated in content creation. Engaging African American community members to qualitatively examine cancer prevention has value in improving implementation strategy and planning for behavioral clinical trials.
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Affiliation(s)
- John S Luque
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA.
| | - Matthew Vargas
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Kristin Wallace
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA
- Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Olayemi O Matthew
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Rima Tawk
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Askal A Ali
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Gebre-Egziabher Kiros
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Cynthia M Harris
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Clement K Gwede
- Moffitt Cancer Center and University of South Florida, 12902 Magnolia Dr., FOW-EDU, Tampa, FL, 33612, USA
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6
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Luque JS, Matthew OO, Jackson DR, Vargas MA, Austin T, Ali A, Kiros GE, Harris CM, Tawk R, Gwede CK, Wallace K, Jean-Pierre P. Assessing the effectiveness of a community health advisor plus screen to save educational intervention on stool-based testing adherence in an African American safety net clinic population: study protocol for a randomized pragmatic trial. Trials 2022; 23:151. [PMID: 35168640 PMCID: PMC8845372 DOI: 10.1186/s13063-022-06076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Colorectal cancer (CRC) is the second most deadly cancer affecting US adults and is also one of the most treatable cancers when detected at an earlier clinical stage of disease through screening. CRC health disparities experienced by African Americans are due in part to the later stage of diagnosis, suggesting the importance of improving African Americans’ CRC screening participation. The national Screen to Save (S2S) initiative employs a community health educator to deliver CRC screening education which can be tailored for specific populations, and such approaches have increased CRC screening rates in disadvantaged and racial/ethnic minority populations. Methods/design In this trial emphasizing stool-based CRC screening, focus groups informed the development of an adapted S2S video and brochure tailored for African Americans and identified preferred motivational text messages for a multicomponent community health advisor (CHA) intervention. A CHA hired from the community was trained to deliver a 6-week CRC educational intervention consisting of an initial face-to-face meeting followed by 5 weeks of calls and texts. Interested eligible persons are enrolled primarily through recruitment by two partnering community health centers (CHCs) and secondarily through various outreach channels and, after consenting and completing a baseline survey, are randomly assigned to one of two study arms. The CHCs are blinded to study arm assignment. Intervention arm participants receive the brochure and CHA intervention while participants assigned to the control group receive only the brochure. All participants receive a stool-based CRC screening test from their health center, and the primary outcome is the completion of the screening test at 12 months. Secondary objectives are to estimate the effect of the intervention on mediating factors, explore the effect of moderating factors, and perform a cost-effectiveness analysis of the CHA intervention. Discussion The TUNE-UP study will enhance understanding about CRC screening in African Americans obtaining primary health care through CHCs and is one of the very few studies to examine a CHA intervention in this context. A better understanding of the mechanisms by which the intervention affects patient beliefs and behaviors will help focus future research while the exploratory cost-effectiveness analysis will inform CHCs’ decision-making about implementing a CHA program to increase screening and reduce cancer health disparities. Trial registration ClinicalTrials.govNCT04304001. Registered on March 11, 2020.
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Affiliation(s)
- John S Luque
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA.
| | - Olayemi O Matthew
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Deloria R Jackson
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Matthew A Vargas
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Tifini Austin
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Askal Ali
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Gebre E Kiros
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Cynthia M Harris
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Rima Tawk
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Clement K Gwede
- Division of Population Sciences, Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Kristin Wallace
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA.,Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Pascal Jean-Pierre
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL, 32306, USA
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Cusumano VT, Myint A, Corona E, Yang L, Bocek J, Lopez AG, Huang MZ, Raja N, Dermenchyan A, Roh L, Han M, Croymans D, May FP. Patient Navigation After Positive Fecal Immunochemical Test Results Increases Diagnostic Colonoscopy and Highlights Multilevel Barriers to Follow-Up. Dig Dis Sci 2021; 66:3760-3768. [PMID: 33609211 DOI: 10.1007/s10620-021-06866-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/20/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND The fecal immunochemical test (FIT) is a common colorectal cancer screening modality in the USA but often is not followed by diagnostic colonoscopy. AIMS We investigated the efficacy of patient navigation to increase diagnostic colonoscopy after positive FIT results and determined persistent barriers to follow-up despite navigation in a large, academic healthcare system. METHODS The study cohort included all health system outpatients with an assigned primary care provider, a positive FIT result between 12/01/2016 and 06/01/2019, and no documentation of colonoscopy after positive FIT. Two non-clinical patient navigators engaged patients and providers to encourage follow-up, offer solutions to barriers, and assist with colonoscopy scheduling. The primary intervention endpoint was completion of colonoscopy within 6 months of navigation. We documented reasons for persistent barriers to colonoscopy despite navigation and determined predictors of successful follow-up after navigation. RESULTS There were 119 patients who received intervention. Of these, 37 (31.1%) patients completed colonoscopy at 6 months. In 41/119 (34.5%) cases, the PCP did not recommend colonoscopy, most commonly due to a normal colonoscopy prior to the positive FIT (19, 46.3%). There were 41/119 patients (34.5%) that declined colonoscopy despite the patient navigator and the PCP order. Male sex and younger age were significant predictors of follow-up (aOR = 2.91, 95%CI, 1.18-7.13; aOR = 0.92, 95%CI, 0.87-0.99). CONCLUSIONS After implementation of patient navigation, diagnostic colonoscopy was completed for 31.1% of patients with a positive FIT result. However, navigation also highlighted persistent multilevel barriers to follow-up. Future work will develop targeted solutions for these barriers to further increase FIT follow-up rates in our health system.
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Affiliation(s)
- Vivy T Cusumano
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Anthony Myint
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Edgar Corona
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Liu Yang
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jennifer Bocek
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Faculty Practice Group and Office of Population Health and Accountable Care, University of California Los Angeles, Los Angeles, CA, USA
| | - Antonio G Lopez
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA
| | - Marcela Zhou Huang
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA
| | - Naveen Raja
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Faculty Practice Group and Office of Population Health and Accountable Care, University of California Los Angeles, Los Angeles, CA, USA
| | - Anna Dermenchyan
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Quality Program, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Lily Roh
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Faculty Practice Group and Office of Population Health and Accountable Care, University of California Los Angeles, Los Angeles, CA, USA
| | - Maria Han
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Quality Program, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel Croymans
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Quality Program, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Folasade P May
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA. .,Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. .,Cancer Prevention Control Research, UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA. .,Department of Medicine, Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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8
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Zhan FB, Morshed N, Kluz N, Candelaria B, Baykal-Caglar E, Khurshid A, Pignone MP. Spatial Insights for Understanding Colorectal Cancer Screening in Disproportionately Affected Populations, Central Texas, 2019. Prev Chronic Dis 2021; 18:E20. [PMID: 33661726 PMCID: PMC7938962 DOI: 10.5888/pcd18.200362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) screening can reduce morbidity and mortality; however, important disparities exist in CRC uptake. Our study examines the associations of distance to care and frequency of using primary care and screening. METHODS To examine the distribution of screening geographically and according to several demographic features, we used individual patient-level data, dated September 30, 2018, from a large urban safety-net health system in Central Texas. We used spatial cluster analysis and logistic regression adjusted for age, race, sex, socioeconomic status, and health insurance status. RESULTS We obtained screening status data for 13,079 age-eligible patients from the health system's electronic medical records. Of those eligible, 55.1% were female, and 55.9% identified as Hispanic. Mean age was 58.1 years. Patients residing more than 20 miles from one of the system's primary care clinics was associated with lower screening rates (odds ratio [OR], 0.63; 95% CI, 0.43-0.93). Patients with higher screening rates included those who had a greater number of primary care-related (nonspecialty) visits within 1 year (OR, 6.90; 95% CI, 6.04-7.88) and those who were part of the county-level medical assistance program (OR, 1.61; 95% CI, 1.40-1.84). Spatial analysis identified an area where the level of CRC screening was particularly low. CONCLUSION Distance to primary care and use of primary care were associated with screening. Priorities in targeted interventions should include identifying and inviting patients with limited care engagements.
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Affiliation(s)
- F Benjamin Zhan
- LiveStrong Cancer Institutes, Dell Medical School, University of Texas, Austin, Texas
- Texas Center for Geographic Information Science, Department of Geography, Texas State University, San Marcos, TX 78666.
| | - Niaz Morshed
- Texas Center for Geographic Information Science, Department of Geography, Texas State University, San Marcos, Texas
| | - Nicole Kluz
- Departments of Internal Medicine and Population Health, University of Texas Dell Medical School, Austin, Texas
| | - Bretta Candelaria
- Departments of Internal Medicine and Population Health, University of Texas Dell Medical School, Austin, Texas
| | | | - Anjum Khurshid
- Departments of Internal Medicine and Population Health, University of Texas Dell Medical School, Austin, Texas
| | - Michael P Pignone
- LiveStrong Cancer Institutes, Dell Medical School, University of Texas, Austin, Texas
- Departments of Internal Medicine and Population Health, University of Texas Dell Medical School, Austin, Texas
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Ferlizza E, Solmi R, Sgarzi M, Ricciardiello L, Lauriola M. The Roadmap of Colorectal Cancer Screening. Cancers (Basel) 2021; 13:1101. [PMID: 33806465 PMCID: PMC7961708 DOI: 10.3390/cancers13051101] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer (CRC) is the third most common form of cancer in terms of incidence and the second in terms of mortality worldwide. CRC develops over several years, thus highlighting the importance of early diagnosis. National screening programs based on fecal occult blood tests and subsequent colonoscopy have reduced the incidence and mortality, however improvements are needed since the participation rate remains low and the tests present a high number of false positive results. This review provides an overview of the CRC screening globally and the state of the art in approaches aimed at improving accuracy and participation in CRC screening, also considering the need for gender and age differentiation. New fecal tests and biomarkers such as DNA methylation, mutation or integrity, proteins and microRNAs are explored, including recent investigations into fecal microbiota. Liquid biopsy approaches, involving novel biomarkers and panels, such as circulating mRNA, micro- and long-non-coding RNA, DNA, proteins and extracellular vesicles are discussed. The approaches reported are based on quantitative PCR methods that could be easily applied to routine screening, or arrays and sequencing assays that should be better exploited to describe and identify candidate biomarkers in blood samples.
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Affiliation(s)
- Enea Ferlizza
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy; (R.S.); (M.S); (M.L.)
| | - Rossella Solmi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy; (R.S.); (M.S); (M.L.)
| | - Michela Sgarzi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy; (R.S.); (M.S); (M.L.)
| | - Luigi Ricciardiello
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
| | - Mattia Lauriola
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy; (R.S.); (M.S); (M.L.)
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Petersen MM, Ferm L, Kleif J, Piper TB, Rømer E, Christensen IJ, Nielsen HJ. Triage May Improve Selection to Colonoscopy and Reduce the Number of Unnecessary Colonoscopies. Cancers (Basel) 2020; 12:E2610. [PMID: 32932734 PMCID: PMC7563245 DOI: 10.3390/cancers12092610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 12/18/2022] Open
Abstract
Implementation of population screening for colorectal cancer by direct colonoscopy or follow-up colonoscopy after a positive fecal blood test has challenged the overall capacity of bowel examinations. Certain countries are facing serious colonoscopy capacity constraints, which have led to waiting lists and long time latency of follow-up examinations. Various options for improvement are considered, including increased cut-off values of the fecal blood tests. Results from major clinical studies of blood-based, cancer-associated biomarkers have, however, led to focus on a Triage concept for improved selection to colonoscopy. The Triage test may include subject age, concentration of hemoglobin in a feces test and a combination of certain blood-based cancer-associated biomarkers. Recent results have indicated that Triage may reduce the requirements for colonoscopy by around 30%. Such results may be advantageous for the capacity, the healthcare budgets and in particular, the subjects, who do not need an unnecessary, unpleasant and risk-associated bowel examination.
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Affiliation(s)
- Mathias M. Petersen
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Linnea Ferm
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Jakob Kleif
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Thomas B. Piper
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Eva Rømer
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Ib J. Christensen
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Hans J. Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
- Institute of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
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Murphy CC, Halm EA, Skinner CS, Balasubramanian BA, Singal AG. Challenges and Approaches to Measuring Repeat Fecal Immunochemical Test for Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev 2020; 29:1557-1563. [PMID: 32457184 DOI: 10.1158/1055-9965.epi-20-0230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/14/2020] [Accepted: 05/11/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Colorectal cancer screening with fecal immunochemical testing (FIT) can reduce colorectal cancer-related mortality. Effectiveness of FIT may be compromised when patients do not adhere to a regular schedule. However, having no standard measure of repeat FIT presents challenges for assessing effectiveness across populations and settings. We compared three measures of repeat FIT in a large, integrated health care system in Dallas, Texas. METHODS We identified 18,257 patients age-eligible (50-60 years) for FIT in January 1-December 31, 2010 and followed over four rounds of screening. Measures included: (i) repeat FIT in prior screeners, or completion of FIT within 9-15 months of the previous; (ii) yes-no patterns, whereby patients were assigned yes or no in 9-15 month windows; and 3) proportion of time covered (PTC), or the amount of time patients were up-to-date with screening relative to time eligible. RESULTS Repeat FIT varied by measure. Using a prior screeners measure, 15.8% of patients with a normal FIT in round 1 completed repeat FIT in round 2. Repeat FIT was notably higher (52.3%) using PTC. The most common yes-no pattern was YNNN or "one-and-done," and only 9.4% of patients completed two consecutive FITs across all rounds (YYNN). CONCLUSIONS Different measures of repeat FIT yielded a range of estimates, making comparison across studies difficult. Researchers should weigh the advantages and disadvantages of each measure and select the most appropriate to their research question. IMPACT Our study highlights the need for future research of repeat FIT measures that best approximate screening effectiveness.
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Affiliation(s)
- Caitlin C Murphy
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Ethan A Halm
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Celette Sugg Skinner
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Bijal A Balasubramanian
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
- Department of Epidemiology, Human Genetics, and Environmental Science, UTHealth School of Public Health in Dallas, Dallas, Texas
| | - Amit G Singal
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
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