Green Beverly B, Anderson Melissa L, Cook Andrea J, Chubak Jessica, Fuller Sharon, Meenan Richard T, Vernon Sally W
Kaiser Permanente Washington, Seattle, Washington.
Kaiser Permanente Health Research Institute, Seattle, Washington.
Cancer. 2017 Nov 15;123(22):4472-4480. doi: 10.1002/cncr.30908. Epub 2017 Jul 28.
Screening over many years is required to optimize reductions in colorectal cancer (CRC) mortality. However, no prior trials have compared strategies for obtaining long-term adherence.
Systems of Support to Increase Colorectal Cancer Screening and Follow-Up was implemented in an integrated health care organization in Washington State. Between 2008 and 2009, 4675 individuals aged 50 to 74 years were randomized to receive the usual care (UC), which included clinic-based strategies to increase CRC screening (arm 1), or, in years 1 and 2, mailings with a call-in number for colonoscopy and mailed fecal tests (arm 2), mailings plus brief telephone assistance (arm 3), or mailings and assistance plus nurse navigation (arm 4). Active-intervention subjects (those in arms 2, 3, and 4 combined) who were still eligible for CRC screening were randomized to mailings being stopped or continued in years 3 and 5. The time in compliance with CRC screening over 5 years was compared for persons assigned to any intervention and persons assigned to UC. Screening tests contributed time on the basis of national guidelines for screening intervals (fecal tests annually, sigmoidoscopy every 5 years, and colonoscopy every 10 years).
All participants contributed data, but they were censored at disenrollment, death, the age of 76 years, or a diagnosis of CRC. Compared with UC participants, intervention participants had 31% more adjusted covered time over 5 years (incidence rate ratio, 1.31; 95% confidence interval, 1.25-1.37; covered time, 47.5% vs 62.1%). Fecal testing accounted for almost all additional covered time.
In a health care organization with clinic-based activities to increase CRC screening, a centralized program led to increased CRC screening adherence over 5 years. Longer term data on screening adherence and its impact on CRC outcomes are needed. Cancer 2017;123:4472-80. © 2017 American Cancer Society.
需要多年的筛查才能优化降低结直肠癌（CRC）死亡率。然而，之前尚无试验比较获得长期依从性的策略。
在华盛顿州的一个综合医疗保健机构实施了增加结直肠癌筛查及随访支持系统。2008年至2009年期间，4675名年龄在50至74岁之间的个体被随机分配接受常规护理（UC），其中包括基于诊所的增加CRC筛查的策略（第1组），或者在第1年和第2年，邮寄带有结肠镜检查热线电话的信件以及邮寄粪便检测（第2组），邮寄信件加简短电话协助（第3组），或邮寄信件、协助加护士导航（第4组）。仍符合CRC筛查条件的积极干预受试者（第2、3和4组合组）在第3年和第5年被随机分配停止或继续邮寄信件。比较了分配到任何干预措施的人与分配到UC的人在5年内符合CRC筛查的时间。筛查测试根据国家筛查间隔指南（每年进行粪便检测，每5年进行乙状结肠镜检查，每10年进行结肠镜检查）计算时间。
所有参与者都提供了数据，但在退出、死亡、76岁或被诊断为CRC时被审查。与UC参与者相比，干预参与者在5年内的调整后覆盖时间多31%（发病率比，1.31；95%置信区间，1.25 - 1.37；覆盖时间，47.5%对62.1%）。粪便检测几乎占了所有额外的覆盖时间。
在一个有基于诊所活动以增加CRC筛查的医疗保健机构中，一个集中化项目导致5年内CRC筛查依从性增加。需要关于筛查依从性及其对CRC结局影响的更长期数据。《癌症》2017年；123:4472 - 4480。©2017美国癌症协会。
