Simple Test Kit May Screen Colorectal Cancer

Default implementation of the take-at-home test to the patient's home for colorectal cancer screening escalated the test rates to more than 1,000 per cent as per the research from the Perelman School of Medicine at the University of Pennsylvania, published in the Journal of General Internal Medicine. Rather than reminding a patient simply that they are overdue for screening, the team sent the test to be performed at the home of patients (unless they opted out via a text message prompt) who were overdue for testing at a community health center that predominantly serves people of color.

Colorectal cancer screening rates are limited in underserved populations. It is a type of cancer that affects the colon and the rectum and can be deadly if not discovered at early stages. Black people had a 40% higher risk of developing colorectal cancer as compared to white people with 100% higher than in Asian/Pacific Islanders.

The screening test kit – fecal immunochemical test (FIT) requires a stool sample from a patient that is then returned to a laboratory by mail and analyzed for the trace blood associated with colorectal cancer. However unlike the gold standard colonoscopy which is done once every 10 years, FIT kits only clear a patient for a year.

Thus to increase these low completion rates, the study randomly divided a group of more than 400 patients (90% of them were Black, and 50% were Medicaid beneficiaries) overdue for screenings into two equal arms from March to May 2018 (12 weeks): one that just received a single reminder text (the control group) and another that received FIT kits along with proven behavioral science techniques unless patients sent a response to opt-out (the intervention group).

Take-at-home Test Kit for Colorectal Cancer

It was observed that ~2% of the control group patients had completed a FIT kit or had a colonoscopy whereas the intervention group included around 20% of the patients who had done the test.

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"It is important to note that this is a population at a community health center that may not routinely seek out medical care, especially preventive care, so there is a low baseline screening rate. Future interventions may need to address issues such as reading comprehension and not having a stable place to live", says Sarah Huf, MBBS, a former Commonwealth Fund Fellow at Penn and now an Honorary Clinical Lecturer at Imperial College London.

The study was performed at the cost of only $150 for 200 patients in the intervention arm. "For these types of health clinics, minimizing cost is critical for sustainability since they have many competing health priorities for their patients," says Shivan Mehta, MD, associate chief innovation officer at Penn Medicine and an assistant professor of Medicine.

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The study is yet to explore the other choices of colonoscopy or FIT kits that can be best offered to patients in the populations that receive care at this type of health center.

Source-Medindia