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Intervention ups annual FOBT screening to 82%

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Only the first step

Dramatically improving the rate of annual FOBT screening for colorectal cancer is an essential first step, but patients might be "unpleasantly surprised to learn that, depending on their health plan, colonoscopy after a positive FOBT could cost from $200 to $3,000," said Dr. Beverly B. Green and Gloria D. Coronado, Ph.D.

Reducing the disparities in colorectal cancer deaths requires that insurance policies be changed so that screening colonoscopy is also covered. FOBT must be treated as the first part of a two-part test, with the second part being colonoscopy for those who get a positive result on FOBT, they said.

Dr. Green is at Group Health Cooperative and Group Health Research Institute, both in Seattle. Dr. Coronado is at Kaiser Permanente Center for Health Research Northwest in Portland, Ore. They reported no financial conflicts of interest. These remarks were taken from their invited commentary accompanying Dr. Baker’s report (JAMA Intern. Med. 2014 June 16 [doi:10.1001/jamainternmed.2014.730]).


 

FROM JAMA INTERNAL MEDICINE

An inexpensive telephone intervention raised the rate of annual colorectal cancer screening using fecal occult blood testing to 82% in an underserved population at particular risk for poor health, according to a report published online June 16 in JAMA Internal Medicine.

In this clinical trial, 450 people aged 51-75 years (mean age, 60 years) treated at four Chicago community clinics were randomly assigned to either usual care or an intervention in which they were given take-home fecal immunochemical test (FIT) kits and followed by automated telephone or text message to encourage adherence. Most of the study participants were Hispanic (approximately 90%) and impoverished (91%); more than 75% of them were uninsured, said Dr. David W. Baker of the department of medicine, Northwestern University, Chicago, and his associates.

A total of 82.2% of the intervention group completed the FIT within 6 months – an annual screening rate that has been shown to reduce colorectal cancer mortality – compared with only 37.3% of the usual-care group. The median time to completion of the FIT was 13 days in the intervention group, compared with 83 days in the usual-care group. The estimated cost of the intervention was less than $35 per patient, the investigators said (JAMA Intern. Med. 2014 June 16 [doi:10.1001/jamainternmed.2014.2352]).

"Our study suggests that it is possible to achieve high annual FOBT adherence rates even among highly vulnerable populations," they said.

It is hoped that this strategy will reduce ethnic and socioeconomic disparities in colorectal cancer mortality, Dr. Baker and his associates added.

This study was funded by the Agency for Healthcare Research and Quality. No financial conflicts of interest were reported.

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