Mailed Tests Boost Colorectal Screening in Veterans
Mailed fecal immunochemical test kits with reminders increased colorectal cancer screening to 26.1% in veterans without a recent primary care visit, > 4 times the rate with usual care in a randomized trial.
TOPLINE: Mailed fecal immunochemical test (FIT) kits with reminder phone calls promote colorectal cancer (CRC) screening among veterans without recent primary care visits. Among 782 veterans in a randomized controlled trial (RCT), mailed FITs resulted in a 26.1% screening completion rate within 6 months, compared with 5.8% for usual care and 7.7% for mailed invitations with reminders. Improving screening in this population may help CRC morbidity and mortality among veterans.
METHODOLOGY
Researchers conducted a 3-arm pragmatic RCT at the US Department of Verterans Affairs (VA) Corporal Michael J. Crescenz VA Medical Center (CMC-VAMC), enrolling veterans aged 50 to 75 years without a primary care visit within 18 months.
Participants were randomized 1:1:1 to usual care (n = 260), mailed clinic-based screening invitation with reminder calls (n = 261), or mailed home FIT outreach plus prenotification letter and reminder phone calls (n = 261).
Outcome measures included documented completion of CRC screening within 6 months after randomization in the electronic health record (EHR); a secondary outcome was FIT return within 6 months among those mailed FIT.
Eligibility and exclusions were based on chart review and EHR criteria (eg, excluding symptoms, family history, inflammatory bowel disease, prior resection, or being current by having undergone a colonoscopy within 10 years, sigmoidoscopy or barium enema within 5 years, or fecal occult blood testing within 1 year).
TAKEAWAY
CRC screening completion within 6 months is 26.1% with mailed FIT vs 5.8% with usual care (RD, 20.3%; 95% CI, 14.3%-26.3%; RR, 4.5; 95% CI, 2.7-7.7; P < .001).
CRC screening completion within 6 months is 26.1% with mailed FIT vs 7.7% with mailed invitation plus reminders (RD, 18.4%; 95% CI, 12.2%-24.6%; RR, 3.4; 95% CI, 2.1-5.4; P < .001).
Screening completion does not differ between mailed invitation plus reminders (7.7%) and usual care (5.8%), and the comparison is not statistically supported (RR, 1.3; P = .39).
No statistically significant differences in screening completion are reported by age or race/ethnicity, and investigators also report no significant differences in FIT return by age or race/ethnicity in the secondary analysis.
IN PRACTICE
“This research represents the first pragmatic RCT of mailed FIT outreach screening among veterans who have not recently (18 months) used primary care services offered by the VA. In this work, there were large relative, and absolute differences in CRC screening participation rate between veterans offered home FIT screening and those who received usual care (RR = 4.52, RD = 20.2%) or a mailed invitation plus reminders (RR = 3.40, RD = 18.4%)," wrote the authors.
SOURCE
The study was led by Matthew A. Goldshore, MD, PhD, MPH, of the CMC-VAMC . It was published online in Am J Prev Med.
LIMITATIONS
The study was not able identify differences in screening completion or FIT return by patient demographic characteristics such as age and race. The sample was randomized from predominantly male veterans cared for at a single VA medical center, limiting generalizability and reducing external validity. Follow-up and subsequent evaluation of FIT-positive participants is needed for the success of a mailed FIT intervention; of the 3 FIT-positive participants who should have received follow-up evaluation, only 1 underwent colonoscopy, highlighting the challenge of FIT to colonoscopy among participants who do not use care regularly at the CMC-VAMC.
DISCLOSURES
This trial received funding from an VA Health Services Research and Development Service award, with E. Carter Paulson, MD, MSCE, and Chyke A. Doubeni, MD, MPH, serving as principal investigators. Chyke A. Doubeni received support from grant number RO1CA 213645, and Shivan J. Mehta received support from grant number K08CA 234326, both from the National Cancer Institute of the National Institutes of Health. The authors reported no financial disclosures.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.