Singal Amit G, Gupta Samir, Tiro Jasmin A, Skinner Celette Sugg, McCallister Katharine, Sanders Joanne M, Bishop Wendy Pechero, Agrawal Deepak, Mayorga Christian A, Ahn Chul, Loewen Adam C, Santini Noel O, Halm Ethan A
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Parkland Health and Hospital System, Dallas, Texas.
Cancer. 2016 Feb 1;122(3):456-63. doi: 10.1002/cncr.29770. Epub 2015 Nov 4.
The effectiveness of colorectal cancer (CRC) screening is limited by underuse, particularly among underserved populations. Among a racially diverse and socioeconomically disadvantaged cohort of patients, the authors compared the effectiveness of fecal immunochemical test (FIT) outreach and colonoscopy outreach to increase screening participation rates, compared with usual visit-based care.
Patients aged 50 to 64 years who were not up-to-date with CRC screening but used primary care services in a large safety-net health system were randomly assigned to mailed FIT outreach (2400 patients), mailed colonoscopy outreach (2400 patients), or usual care with opportunistic visit-based screening (1199 patients). Patients who did not respond to outreach invitations within 2 weeks received follow-up telephone reminders. The primary outcome was CRC screening completion within 12 months after randomization.
Baseline patient characteristics across the 3 groups were similar. Using intention-to-screen analysis, screening participation rates were higher for FIT outreach (58.8%) and colonoscopy outreach (42.4%) than usual care (29.6%) (P <.001 for both). Screening participation with FIT outreach was higher than that for colonoscopy outreach (P <.001). Among responders, FIT outreach had a higher percentage of patients who responded before reminders (59.0% vs 29.7%; P <.001). Nearly one-half of patients in the colonoscopy outreach group crossed over to complete FIT via usual care, whereas <5% of patients in the FIT outreach group underwent usual-care colonoscopy.
Mailed outreach invitations appear to significantly increase CRC screening rates among underserved populations. In the current study, FIT-based outreach was found to be more effective than colonoscopy-based outreach to increase 1-time screening participation. Studies with longer follow-up are needed to compare the effectiveness of outreach strategies for promoting completion of the entire screening process.
结直肠癌（CRC）筛查的有效性因未充分利用而受限，尤其是在服务不足的人群中。在一个种族多样且社会经济处于不利地位的患者队列中，作者比较了粪便免疫化学检测（FIT）外展服务和结肠镜检查外展服务与常规基于就诊的护理相比，在提高筛查参与率方面的有效性。
年龄在50至64岁之间、未进行最新CRC筛查但在一个大型安全网卫生系统中使用初级保健服务的患者被随机分配至邮寄FIT外展服务组（2400例患者）、邮寄结肠镜检查外展服务组（2400例患者）或常规机会性基于就诊的筛查护理组（1199例患者）。在2周内未对外展邀请做出回应的患者会收到后续电话提醒。主要结局是随机分组后12个月内完成CRC筛查。
3组患者的基线特征相似。采用意向性筛查分析，FIT外展服务组（58.8%）和结肠镜检查外展服务组（42.4%）的筛查参与率高于常规护理组（29.6%）（两者P均<.001）。FIT外展服务的筛查参与率高于结肠镜检查外展服务（P<.001）。在做出回应的患者中，FIT外展服务组在收到提醒前做出回应的患者比例更高（59.0%对29.7%；P<.001）。结肠镜检查外展服务组中近一半的患者转而通过常规护理完成FIT，而FIT外展服务组中<5%的患者接受了常规护理结肠镜检查。
邮寄外展邀请似乎能显著提高服务不足人群的CRC筛查率。在本研究中，发现基于FIT的外展服务在提高一次性筛查参与率方面比基于结肠镜检查的外展服务更有效。需要进行更长随访期的研究来比较外展策略在促进完成整个筛查过程方面的有效性。
