Novel Approach to Screen for Colon Cancer Proves Efficacious, Cost Effective

Colon cancer is cancer of the large intestine. Current colon cancer screening tests check for blood in stool or use an instrument called colonoscope to look at the lining of the colon. A new research from Group Health Research Institute has revealed that mailing yearly stool kit, an alternative to the often-dreaded colonoscopy, has helped Group Health to boost rates of lifesaving screening for colon cancer. Group Health researchers mailed an easy-to-use at-home stool kit to test more than 1,000 patients for signs of colorectal cancers. This boosted the screening rate from less than four in 10, to more than half of these hard-to-reach patients, who had never had a colonoscopy and were overdue for screening.

Study leader Beverly B. Green, MD, MPH, a family physician at Group Health and an associate investigator at Group Health Research Institute said, "Once again, Group Health is proving that preventive medicine is the best approach to keeping members healthy. By offering patients of average risk a choice of the stool kit or colonoscopy, we keep narrowing the gap to achieve better colorectal cancer screening rates. Group Health's overall rate of screening for colon cancer (72%) already exceeds Washington state's (59 percent), but we keep trying to boost ours further."

The researchers discuss the pros and cons of both colonoscopy and stool tests with patients in shared decision making. Screening colonoscopy is done once a decade and can remove polyps if present, but it often requires time off work, and an unpleasant bowel-clearing preparation the night before. It involves a procedure in which a doctor uses a flexible scope to visually inspect the inside of the colon. The stool test is less expensive and done quickly at home, but it should be done every year. And if it finds blood in the stool, which suggests cancer, a follow-up colonoscopy is still needed.

Dr. Green said, "Screening has been proven to reduce deaths from colorectal cancer, but only if people are screened regularly, as advised for 50- to 75-year-olds of average risk--but too often not done. What matters most is maximizing how many people are screened regularly. The best test is the one that gets done."

Over the first two years of the 10-year study, researchers doubled the colorectal cancer screening rates for Group Health patients who had previously been overdue for screening, while significantly lowering health care costs. It used electronic health records to identify patients who were not screened regularly for colon cancer, to encourage these patients with automated reminders to be screened, and to mail them at-home stool kits. And nurse navigators helped the patients to get needed follow-up care after positive screening tests.

Researchers reported that with the centralized electronic health record-linked program, 53% patients were screened for colorectal cancer, versus 37% in those receiving usual care during that year. This difference was entirely due to greater completion of stool tests, rather than colonoscopy, which was also offered as an option.

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The benefit of increased screening was confined to those patients who had responded by doing stool tests in at least one of the first two years. Third-year screening rates were highest in patients completing a stool test in both the first and second years (77%), followed by patients doing a test in one of the two years (45%), with low screening rates in patients who had not taken any stool test in the first two years (18%).

Dr. Green said, "It's important for us to reach the people who are didn't respond to this intervention at all over three years. This study may provide some hints about who these patients might be- They tended to report their own health as 'fair to poor' and not to have made any primary care or preventive visits in the three years. There was also a statistically insignificant trend toward less screening in African American and Latino patients--but no differences seen by age, sex, education, marriage, or smoking."

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Dr. Green further added, "How can they best be reached? Different types of interventions may be needed for those people who consistently refuse a mailed stool kit program. For example, a physician recommendation may be particularly important for this group of patients. Studies testing this and other strategies should be the focus of future research."

The research team will continue to follow up with the same patients for up to 10 years to see whether the regular screenings and cost savings persist. They have also shown that systematically mailing stool tests to patients each year is a promising way to help prevent disparities in colon cancer screening.

Source-Eurekalert