University of California Los Angeles Los Angeles, CA
Camille Soroudi, MD1, Greg Goshgarian, MPH, MSc2, Liu Yang, MD, MPH3, Daniel Croymans, MD, MBA, MS3, Folasade P. May, MD, PhD, MPhil3; 1University of California Los Angeles, Los Angeles, CA; 2Central Michigan University College of Medicine, Mount Pleasant, MI; 3UCLA Health, Los Angeles, CA
Introduction: Colorectal cancer (CRC) is common in the United States, with over half of new diagnoses occurring in patients age 65 or older. Despite national guidelines, screening rates remain suboptimal in patients near the upper limit of screening eligibility. Mailed outreach with fecal immunochemical test (FIT) kits with and without patient reminders has increased uptake of FIT and overall screening in multiple studies, including at our medical center. However, the effectiveness of these strategies has not been demonstrated in elderly populations. Methods: We conducted a single-site randomized control trial to evaluate the effectiveness of a) mailed FIT outreach versus b) mailed FIT outreach plus electronic reminder in patients age 65 to 75 in a large academic health center. FIT kits were mailed in August 2019 as part of a biannual FIT mailing program to primary care patients overdue for CRC screening. Those randomized to group b also received a digital alert through the electronic health record (EHR) patient portal to complete the incoming FIT mailer. Patients who died during the 6-month study period were excluded. We used student t tests and chi-square tests to compare patient characteristics across study groups and completion of CRC screening overall and by screening modality (FIT, colonoscopy, flexible sigmoidoscopy, CT colonography, stool DNA) at monthly intervals for a 6-month follow-up period. Results: We randomized 296 patients to the mailed FIT kit group (na) and 291 patients to mailed FIT plus electronic reminder group (nb). Mean age was 69.6 years, and baseline characteristics in the two study groups were similar (Table 1). In the mailed FIT group, FIT completion was 27.4% (na=81) at six months, compared to 29.9% (nb=87) in the mailed FIT plus electronic reminder group (p=0.50). There was no statistically significant difference in overall CRC screening completion (p=0.56) or screening completion by modality between groups at each month or at 6 months (Figure 1,2). Discussion: In elderly patients overdue for CRC screening, uptake of mailed FIT was modest, and the addition of an electronic reminder did not significantly improve screening uptake. Our results do not support expending resources to add electronic reminders for geriatric patients enrolled in mailed FIT outreach. Further investigation is needed to understand utilization of EHR-based patient portals in this population.
Table 1: Characteristics of the study cohort and participation in screening overall and by intervention group; N=587
Figure 1: Overall CRC screening uptake for each study group over time. CRC, colorectal cancer. *No patients completed stool DNA or CT colonography. Two patients in group b competed flexible sigmoidoscopy. *There was no statistically significant difference in overall CRC screening completion or screening completion by modality between groups at each month or at 6 months.
Figure 2: FIT uptake for each study group over time. CRC, colorectal cancer. *There was no statistically significant difference in FIT completion between groups at each month or at 6 months.
Disclosures: Camille Soroudi indicated no relevant financial relationships. Greg Goshgarian indicated no relevant financial relationships. Liu Yang indicated no relevant financial relationships. Daniel Croymans indicated no relevant financial relationships. Folasade May indicated no relevant financial relationships.