INCREASE IN COLORECTAL CANCER SCREENING IN A SAFETY-NET HOSPITAL AFTER IMPLEMENTING MAIL-ABLE FECAL IMMUNOCHEMICAL TESTS

ABSTRACT

Background Colorectal cancer (CRC) screening rates are typically lower in public safety-net hospital systems, and optimal screening modalities have yet to be determined in this population. There is evidence that fecal immunochemical test (FIT) is a cost-effective approach in this setting, especially as the COVID-19 pandemic decreased the accessibility of colonoscopy. Mailed FIT outreach programs have been shown to markedly increased CRC screening for vulnerable patients. However, there is limited evidence regarding individual facets of these programs, such as returning FIT by mail. In the process of establishing a complete mailed FIT program during the pandemic, we evaluate the effect of allowing patients to mail back a completed FIT they received in person. Methods Patients at a safety-net hospital in New York City aged 50-75 who were not up to date with CRC screening were evaluated. We included patients 30 days before and after the implementation of mail-able FIT kits in July 2021. All patients due for CRC screening were only offered FIT as a screening modality, and prior to the intervention were required to visit the clinic to both obtain and return the FIT. We implemented a partial mailed FIT program, in which FITs picked up in clinic can be mailed directly to the lab after completion. We also randomly surveyed patients who received a FIT and did not complete it in the period prior to our intervention to assess reasons for incompletion. Results A total of 5,153 and 5,180 patients aged 50-75 were seen in clinic 30 days prior and 30 days after the implementation of the mail-able FIT kit respectively. A total of 571 patients were provided a FIT kit that required a return trip to the clinic for completion. Of these patients, 289 (50.6%) completed a FIT. In comparison, there were a total of 781 patients who were provided a FIT kit allowed to be mailed back for completion. Of these patients, 464 (59.4%) completed a FIT (p < 0.01). A total of 45 patients with an incomplete FIT prior to the intervention were called, and 12 patients were reached. Of these patients, 10 endorsed forgetting about the test, and 2 endorsed difficulty scheduling time to drop off the test. Conclusion Organized mailed FIT outreach was previously shown to improve CRC screening in a safety-net setting. We have further shown that implementing a program with FIT kits that can be mailed back significantly improves screening. While our mail-able kits would improve screening in patients with difficulty returning to clinic, many in our population would potentially benefit from reminders to complete. Future work could assess long-term completion rates of our program, and compare it with a full mailed FIT outreach program to quantify the potential increased benefit of also mailing kits to patients.