An RCT of Fecal Immunochemical Test Colorectal Cancer Screening in Veterans Without Recent Primary Care

Overview

Journal Am J Prev Med

Specialty Public Health

Date 2020 Jun 23

PMID 32564804

Citations 2

Authors

Matthew A Goldshore

Shivan J Mehta

Woodrow Fletcher

George Tzanis

Chyke A Doubeni

E Carter Paulson

Affiliations

Soon will be listed here.

Abstract

Introduction: The use of screening can prevent death from colorectal cancer, yet people without regular healthcare visits may not realize the benefits of this preventive intervention. The objective of this study was to determine the effectiveness of a mailed screening invitation or mailed fecal immunochemical test in increasing colorectal cancer screening uptake in veterans without recent primary care encounters.

Study Design: Three-arm pragmatic randomized trial.

Setting/participants: Participants were screening-eligible veterans aged 50-75 years, without a recent primary care visit who accessed medical services at the Corporal Michael J. Crescenz Veteran Affairs Medical Center between January 1, 2017, and July 31, 2017. All data were analyzed from March 1, 2018, to July 31, 2018.

Intervention: Participants were randomized to (1) usual opportunistic screening during a healthcare visit (n=260), (2) mailed invitation to screen and reminder phone calls (n=261), or (3) mailed fecal immunochemical test outreach plus reminder calls (n=61).

Main Outcome Measures: The main outcome under investigation was the completion of colorectal cancer screening within 6 months after randomization.

Results: Of 782 participants in the trial, 53.9% were aged 60-75 years and 59.7% were African American. The screening rate was higher in the mailed fecal immunochemical test group (26.1%) compared with usual care (5.8%) (rate difference=20.3%, 95% CI=14.3%, 26.3%; RR=4.52, 95% CI=2.7, 7.7) or screening invitation (7.7%) (rate difference=18.4%, 95% CI=12.2%, 24.6%; RR=3.4, 95% CI=2.1, 5.4). Screening completion rates were similar between invitation and usual care (rate difference=1.9%, 95% CI= -2.4%, 6.2%; RR=1.3, 95% CI=0.7, 2.5).

Conclusions: Mailed fecal immunochemical test screening promotes colorectal cancer screening participation among veterans without a recent primary care encounter. Despite the addition of reminder calls, an invitation letter was no more effective in screening participation than screening during outpatient appointments.

Trial Registration: This study is registered at clinicaltrials.gov NCT02584998.

Citing Articles

Automated Reminders Enhance Mailed Fecal Immunochemical Test Completion Among Veterans: a Randomized Controlled Trial.

Deeds S, Schuttner L, Wheat C, Gunnink E, Geyer J, Beste L J Gen Intern Med. 2023; 39(1):113-119.

PMID: 37731137 PMC: 10817873. DOI: 10.1007/s11606-023-08409-8.

A stepped randomized trial to promote colorectal cancer screening in a nationwide sample of U.S. Veterans.

Vernon S, Del Junco D, Coan S, Murphy C, Walters S, Friedman R Contemp Clin Trials. 2021; 105:106392.

PMID: 33823295 PMC: 8172445. DOI: 10.1016/j.cct.2021.106392.

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