scholarly journals Assessing Colorectal Cancer Screening Adherence of Medicare Fee-for-Service Beneficiaries Age 76 to 95 Years

2016 ◽  
Vol 12 (6) ◽  
pp. e670-e680 ◽  
Author(s):  
John Bian ◽  
Charles Bennett ◽  
Gregory Cooper ◽  
Alessandra D'Alfonso ◽  
Deborah Fisher ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Odds Ratio ◽  
Patient Adherence ◽  
Adherence Rate ◽  
Average Risk ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Crc Screening ◽  
The Status ◽  
Screening Adherence

Introduction: There are concerns about potential overuse of colorectal cancer (CRC) screening services among average-risk individuals older than age 75 years. Materials and Methods: Using a 5% random noncancer sample of Medicare beneficiaries who resided in the SEER areas, we examined rates of CRC screening adherence, defined by the Medicare coverage policy, among average-risk fee-for-service beneficiaries age 76 to 95 years from 2002 to 2010. The two outcomes are the status of overall CRC screening adherence, and the status of adherence to colonoscopy (v other modalities) conditional on patient adherence. Results: Overall CRC screening adherence rates of Medicare beneficiaries age 76 to 95 years increased from 13.0% to 21.4% from 2002 to 2010. In 2002, 2.2% of beneficiaries were adherent to colonoscopy, and 10.7%, by other modalities; the corresponding rates were 19.5% and 1.9%, respectively, in 2010. Specifically, rates of adherence to colonoscopy were 1.1% for those age 86 to 90 years and almost nil for those age 91 to 95 years in 2002, but the rates became 13.5% and 8.2%, respectively, in 2010. Compared with white beneficiaries, black beneficiaries age 76 to 95 years had a 7-percentage-point lower adherence rate. However, overall adherence rates among blacks increased by 168.6% from 2002 to 2010, whereas rates among whites increased by 63.0%. Logistic regressions showed that blacks age 86 to 95 years were less likely than whites to be adherent (odds ratio, 0.56; 95% CI, 0.47 to 0.59) but were more likely to be adherent to colonoscopy (odds ratio, 2.34; 95% CI, 1.47 to 3.91). Conclusion: High proportions of average-risk Medicare fee-for-service beneficiaries screened by colonoscopy may represent opportunities for improving appropriateness and allocative efficiency of CRC screening by Medicare.

scholarly journals Cross-sectional adherence with the multi-target stool DNA test for colorectal cancer screening in a large, nationally insured cohort

2021 ◽  
Author(s):  
Lesley-Ann Miller-Wilson ◽  
Lila J Finney Rutten ◽  
Jack Van Thomme ◽  
A Burak Ozbay ◽  
Paul J Limburg
Keyword(s):  
Colorectal Cancer ◽  
National Sample ◽  
Adherence Rate ◽  
Average Risk ◽  
Cross Sectional ◽  
Commercial Insurance ◽  
Dna Test ◽  
Crc Screening ◽  
Stool Dna ◽  
Insured Patients

Abstract Purpose Colorectal cancer (CRC) is the second most deadly cancer in the USA. Early detection can improve CRC outcomes, but recent national screening rates (62%) remain below the 80% goal set by the National Colorectal Cancer Roundtable. Multiple options are endorsed for average-risk CRC screening, including the multi-target stool DNA (mt-sDNA) test. We evaluated cross-sectional mt-sDNA test completion in a population of commercially and Medicare-insured patients. Methods Participants included individuals ages 50 years and older with commercial insurance or Medicare, with a valid mt-sDNA test shipped by Exact Sciences Laboratories LLC between January 1, 2018, and December 31, 2018 (n = 1,420,460). In 2020, we analyzed cross-sectional adherence, as the percent of successfully completed tests within 365 days of shipment date. Results Overall cross-sectional adherence was 66.8%. Adherence was 72.1% in participants with Traditional Medicare, 69.1% in participants with Medicare Advantage, and 61.9% in participants with commercial insurance. Adherence increased with age: 60.8% for ages 50–64, 71.3% for ages 65–75, and 74.7% for ages 76 + years. Participants with mt-sDNA tests ordered by gastroenterologists had a higher adherence rate (78.3%) than those with orders by primary care clinicians (67.2%). Geographically, adherence rates were highest among highly rural patients (70.8%) and ordering providers in the Pacific region (71.4%). Conclusions Data from this large, national sample of insured patients demonstrate high cross-sectional adherence with the mt-sDNA test, supporting its role as an accepted, noninvasive option for average-risk CRC screening. Attributes of mt-sDNA screening, including home-based convenience and accompanying navigation support, likely contributed to high completion rates.

scholarly journals Effect of Neighborhood and Individual-Level Socioeconomic Factors on Colorectal Cancer Screening Adherence

2021 ◽  
Vol 18 (9) ◽  
pp. 4398
Author(s):  
Kiara N. Mayhand ◽  
Elizabeth A. Handorf ◽  
Angel G. Ortiz ◽  
Evelyn T. Gonzalez ◽  
Amie Devlin ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Study Participant ◽  
Socioeconomic Indicators ◽  
Cross Sectional ◽  
Mixed Effect ◽  
Total Study Population ◽  
Screening Guidelines ◽  
Individual Level ◽  
Crc Screening ◽  
Screening Adherence

Despite the effectiveness of screenings in reducing colorectal cancer (CRC) mortality, ~25% of US adults do not adhere to screening guidelines. Prior studies associate socioeconomic status (SES) with low screening adherence and suggest that neighborhood deprivation can influence CRC outcomes. We comprehensively investigated the effect of neighborhood SES circumstances (nSES), individual SES, and race/ethnicity on adherence to CRC screening in a multiethnic cross-sectional study. Participant surveys assessing 32 individual-level socioeconomic and healthcare access measures were administered from 2017 to 2018. Participant data were joined with nine nSES measures from the US Census at the census tract level. Univariate, LASSO, and multivariable mixed-effect logistic regression models were used for variable reduction and evaluation of associations. The total study population included 526 participants aged 50–85; 29% of participants were non-adherent. In the final multivariable model, age (p = 0.02) and Non-Hispanic Black race (p = 0.02) were associated with higher odds of adherence. Factors associated with lower adherence were home rental (vs. ownership) (p = 0.003), perception of low healthcare quality (p = 0.006), no routine checkup within two years (p = 0.002), perceived discrimination (p = 0.02), and nSES deprivation (p = 0.02). After comprehensive variable methods were applied, socioeconomic indicators at the neighborhood and individual level were found to contribute to low CRC screening adherence.

scholarly journals Cost-Effectiveness of Colonoscopy-Based Colorectal Cancer Screening in Childhood Cancer Survivors

2019 ◽  
Vol 111 (11) ◽  
pp. 1161-1169 ◽  
Author(s):  
Andrea Gini ◽  
Reinier G S Meester ◽  
Homa Keshavarz ◽  
Kevin C Oeffinger ◽  
Sameera Ahmed ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Average Risk ◽  
Crc Screening ◽  
Colonoscopy Screening ◽  
Life Years ◽  
The Us

Abstract Background Childhood cancer survivors (CCS) are at increased risk of developing colorectal cancer (CRC) compared to the general population, especially those previously exposed to abdominal or pelvic radiation therapy (APRT). However, the benefits and costs of CRC screening in CCS are unclear. In this study, we evaluated the cost-effectiveness of early-initiated colonoscopy screening in CCS. Methods We adjusted a previously validated model of CRC screening in the US population (MISCAN-Colon) to reflect CRC and other-cause mortality risk in CCS. We evaluated 91 colonoscopy screening strategies varying in screening interval, age to start, and age to stop screening for all CCS combined and for those treated with or without APRT. Primary outcomes were CRC deaths averted (compared to no screening) and incremental cost-effectiveness ratios (ICERs). A willingness-to-pay threshold of $100 000 per life-years gained (LYG) was used to determine the optimal screening strategy. Results Compared to no screening, the US Preventive Services Task Force’s average risk screening schedule prevented up to 73.2% of CRC deaths in CCS. The optimal strategy of screening every 10 years from age 40 to 60 years averted 79.2% of deaths, with ICER of $67 000/LYG. Among CCS treated with APRT, colonoscopy every 10 years from age 35 to 65 years was optimal (CRC deaths averted: 82.3%; ICER: $92 000/LYG), whereas among those not previously treated with APRT, screening from age 45 to 55 years every 10 years was optimal (CRC deaths averted: 72.7%; ICER: $57 000/LYG). Conclusions Early initiation of colonoscopy screening for CCS is cost-effective, especially among those treated with APRT.

Preferences of Iranian average risk population for colorectal cancer screening tests

2019 ◽  
Vol 32 (4) ◽  
pp. 677-687
Author(s):  
Vajiheh Ramezani_Doroh ◽  
Alireza Delavari ◽  
Mehdi Yaseri ◽  
Sara Emamgholipour Sefiddashti ◽  
Ali Akbarisari
Keyword(s):  
Colorectal Cancer ◽  
Health Status ◽  
Discrete Choice ◽  
Choice Model ◽  
Screening Tests ◽  
Average Risk ◽  
Risk Population ◽  
Content Type ◽  
Crc Screening ◽  
Complication Risk

Purpose The purpose of this paper is to explore the preferences of the average risk Iranian population for colorectal cancer (CRC) screening tests. Design/methodology/approach A standard stated-preferences method with discrete choice models was used to identify the preferences. Data about socio-demographic status, health status and preferences for CRC screening tests were collected by a structured questionnaire that was completed by 500 people aged 50–75 years. Mixed logit model was used to analyze the preferences. Findings The regression model showed that the test process, pain, place, frequency, preparation, sensitivity, complication risk, mortality rate and cost were the final attributes; that had a statistically significant correlation with the preferences of the people in choosing CRC screening tests. The socio-demographic and health status of participants had no significant correlation with the individuals’ preferences. Practical implications This study provides insight into how different characteristics of a CRC screening test might influence the preferences of individuals about that test. Originality/value This was the first study of this type in Iran to elicit the preferences of the average risk population for CRC screening tests using a discrete choice model.

Effect of anticoagulants and NSAIDs on accuracy of faecal immunochemical tests (FITs) in colorectal cancer screening: a systematic review and meta-analysis

Gut ◽  
2018 ◽  
Vol 68 (5) ◽  
pp. 866-872 ◽  
Author(s):  
Stella A V Nieuwenburg ◽  
Fanny E R Vuik ◽  
Marieke J H A Kruip ◽  
Ernst J Kuipers ◽  
Manon C W Spaander
Keyword(s):  
Colorectal Cancer ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Random Effect ◽  
Premalignant Lesions ◽  
Average Risk ◽  
Crc Screening ◽  
Use Values ◽  
Inflammatory Drugs

ObjectiveMost colorectal cancer (CRC) screening programmes are nowadays based on faecal immunochemical testing (FIT). Eligible subjects often use oral anticoagulants (OACs) or non-steroidal anti-inflammatory drugs (NSAIDs), which could possibly stimulate bleeding from both benign and premalignant lesions in the colon. The aim of this meta-analysis was to study the effect of OACs and NSAIDs use on FIT performance.DesignA systematic search was conducted until June 2017 to retrieve studies from PubMed, Embase, MEDLINE, Web of science, Cochrane Central and Google Scholar. Studies were included when reporting on FIT results in users versus non-users of OACs and/or NSAIDs in average risk CRC screening populations. Primary outcome was positive predictive value for advanced neoplasia (PPVAN) of FIT in relation to OACs/NSAIDs use. Values were obtained by conducting random-effect forest plots.ResultsOur literature search identified 2022 records, of which 8 studies were included. A total of 3563 participants with a positive FIT were included. Use of OACs was associated with a PPVAN of 37.6% (95% CI 33.9 to 41.4) compared with 40.3% (95% CI 38.5 to 42.1) for non-users (p=0.75). Pooled PPVAN in aspirin/NSAID users was 38.2% (95% CI 33.8 to 42.9) compared with 39.4% (95% CI 37.5 to 41.3) for non-users (p=0.59).ConclusionFIT accuracy is not affected by OACs and aspirin/NSAIDs use. Based on the current literature, withdrawal of OACs or NSAIDs before FIT screening is not recommended. Future studies should focus on duration of use, dosage and classes of drugs in association with accuracy of FIT to conduct more specific guideline recommendations.

Fecal DNA Testing for Colorectal Cancer Screening

2020 ◽  
Vol 71 (1) ◽  
pp. 59-69 ◽  
Author(s):  
John M. Carethers
Keyword(s):  
Colorectal Cancer ◽  
Average Risk ◽  
Fecal Dna ◽  
Polyp Detection ◽  
Serrated Polyps ◽  
Crc Screening ◽  
Epigenetic Biomarkers ◽  
Life Years ◽  
Screening Strategies ◽  
Stool Dna

Fecal (or stool) DNA examination is a noninvasive strategy recommended by several medical professional societies for colorectal cancer (CRC) screening in average-risk individuals. Fecal DNA tests assay stool for human DNA shed principally from the colon. Colonic lesions such as adenomatous and serrated polyps and cancers exfoliate cells containing neoplastically altered DNA that may be detected by sensitive assays that target specific genetic and epigenetic biomarkers to discriminate neoplastic lesions from non-neoplastic tissue. Cross-sectional validation studies confirmed initial case-control studies’ assessment of performance of an optimized multitarget stool DNA (mt-sDNA) test, leading to approval by the US Food and Drug Administration in 2014. Compared to colonoscopy, mt-sDNA showed sensitivity of 92% for detection of CRC, much higher than the 74% sensitivity of another recommended noninvasive strategy, fecal immunochemical testing (FIT). Detections of advanced adenomas and sessile serrated polyps were higher with mt-sDNA than FIT (42% versus 24% and 42% versus 5%, respectively), but overall specificity for all lesions was lower (87% versus 95%). The mt-sDNA test increases patient life-years gained in CRC screening simulations, but its cost relative to other screening strategies needs to be reduced by 80–90% or its sensitivity for polyp detection enhanced to be cost effective. Noninvasive CRC screening strategies such as fecal DNA, however, have the potential to significantly increase national screening rates due to their noninvasive nature and convenience for patients.

scholarly journals Assessing Barriers to and Facilitators of Designing a Feasible Colorectal Cancer Screening Program in Mexico City

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 46-46
Author(s):  
Karla Unger-Saldaña ◽  
Minerva Saldaña-Tellez ◽  
Anabelle Bonvecchio ◽  
Michael B. Potter ◽  
Martin Lajous
Keyword(s):  
Public Health ◽  
Colorectal Cancer ◽  
Primary Care ◽  
Health Care ◽  
Mexico City ◽  
Screening Program ◽  
Average Risk ◽  
Culturally Competent ◽  
Educational Materials ◽  
Crc Screening

PURPOSE We undertook a formative qualitative research study to identify optimal participant recruitment, education, and follow-up strategies to facilitate colorectal cancer (CRC) screening in Mexico City. METHODS This study included semistructured individual and focus group interviews with different stakeholders: 36 average-risk laypeople, 16 public health care leaders, 10 primary care personnel, and 4 endoscopy unit personnel. The study protocol was approved by the National Institute of Public Health Institutional Review Board. Written informed consent was obtained from all participants. We analyzed data using the constant comparison method under the theoretical perspectives of the Consolidated Framework for Implementation Research and the Health Belief Model. Tailored CRC screening educational materials—video, postcard, poster, and brochure—were developed on the basis of our findings. Materials were then pretested in 6 additional focus groups and adjusted accordingly. RESULTS We found multiple barriers and facilitators in different dimensions of the CFIR for successful implementation of a FIT-based CRC screening program in this community. The main barriers were the following: inner context related: understaffing and personnel resistance to new programs; individual health care personnel related: CRC misinformation and work overload; outer setting related: underinvestment in primary care and public insecurity; lay individual related: a lack of CRC awareness, low risk perception, and fear of finding out about a serious disease; and intervention related: test costs. Among the principal facilitators were the following: inner setting: a shared perception of a good working environment and strong leadership at the selected clinic; intervention related: FIT test is perceived as easy to do, and potential users liked the idea that the sample can be obtained in the privacy of their homes. Educational materials we tailored on the basis of these findings and were found to be acceptable, understandable, and culturally competent by lay participants. CONCLUSION Our study allowed for the design of a feasible FIT-based CRC screening program and culturally competent materials that will be used to enhance participation.

scholarly journals Factors Influencing Colorectal Cancer Screening Participation

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Antonio Z. Gimeno García
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Health Care System ◽  
Population Based ◽  
Average Risk ◽  
Major Health Problem ◽  
Crc Screening ◽  
Screening Uptake ◽  
Factors Influencing ◽  
Care System

Colorectal cancer (CRC) is a major health problem worldwide. Although population-based CRC screening is strongly recommended in average-risk population, compliance rates are still far from the desirable rates. High levels of screening uptake are necessary for the success of any screening program. Therefore, the investigation of factors influencing participation is crucial prior to design and launches a population-based organized screening campaign. Several studies have identified screening behaviour factors related to potential participants, providers, or health care system. These influencing factors can also be classified in non-modifiable (i.e., demographic factors, education, health insurance, or income) and modifiable factors (i.e., knowledge about CRC and screening, patient and provider attitudes or structural barriers for screening). Modifiable determinants are of great interest as they are plausible targets for interventions. Interventions at different levels (patient, providers or health care system) have been tested across the studies with different results. This paper analyzes factors related to CRC screening behaviour and potential interventions designed to improve screening uptake.

scholarly journals Colorectal cancer screening behaviors among South Asian immigrants in Canada: a qualitative study

2015 ◽  
Vol 11 (2) ◽  
pp. 130-146 ◽  
Author(s):  
Joanne Crawford ◽  
Farah Ahmad ◽  
Dorcas E. Beaton ◽  
Arlene S. Bierman
Keyword(s):  
Colorectal Cancer ◽  
Focus Groups ◽  
South Asian ◽  
Cultural Context ◽  
Future Research ◽  
Average Risk ◽  
Collaborative Partnerships ◽  
Structural Barriers ◽  
Content Type ◽  
Crc Screening

Purpose – The purpose of this paper is to gain an in-depth understanding of beliefs, attitudes, and reasons for decision making about colorectal cancer (CRC) screening among South Asian (SA) immigrants. Design/methodology/approach – Six focus groups conducted in English, Punjabi, and Urdu were held with 42 SA immigrants, 50-74 years old and at average risk for CRC, from November 2012 to May 2013. All focus group discussions were audio-taped and transcribed verbatim. Data analysis used an inductive and systematic approach employing constant comparison techniques. Findings – Three dominant themes emerged. Beliefs and attitudes towards cancer and screening represented SA immigrant’s perceptions that early detection was beneficial; screening was not necessary in the absence of symptoms; cancer was scary; and the loss of previously established bowel practices upon immigration as potential risks for CRC. Knowledge and awareness focused on unscreened participants’ cancer stories; screened participants’ knowledge of CRC, risk factors, and screening; experiential learning from focus groups; and screened participants’ strategies to promote screening. Support and accessibility concentrated on physician support and responsibility to provide information, explanation, and recommend screening to facilitate access. Originality/value – Findings provide novel insights on socio-cultural context, beliefs, and barriers to CRC screening among SA immigrants. Culturally appropriate community-based strategies included story-telling, the use of social networks, and greater physician engagement. Enhancing collaborative partnerships with physicians and public health may minimize structural barriers and reduce health disparities. Future research could explore effectiveness of outreach strategies including these collaborations.

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