P4808 - FIT-based Colorectal Cancer Screening Completion Rates (Initial Test and Follow-up Colonoscopy) by Health Facility Type: A Systematic Review and Meta-Analysis

Xiting Cao, PhD¹, Vahab Vahdat, PhD¹, Heather A. Johnson, MLIS¹, Gina Thompson, PhD¹, Joyce Kong, PharmD², Irem Betül Koçak, PhD³, Carol Kirshner, MS⁴, A. Burak Ozbay, PhD¹, Thomas Imperiale, MD⁵, Mohammad Dehghani, PhD⁶, Michael Dore, MD⁷, Portia Zaire, PhD⁸, A. Mark Fendrick, MD⁸, Paul J. Limburg, MD¹
1Exact Sciences, Madison, WI; 2Rutgers University, Piscataway, NJ; 3Value Analytics Labs, Madison, WI; 4Value Analytics Labs, Boston, MA; 5Indiana University School of Medicine, Indianapolis, IN; 6Northeastern University, Boston, MA; 7Duke University School of Medicine, Durham, NC; 8University of Michigan, Ann Arbor, MI

Introduction: Stool-based strategies for colorectal cancer (CRC) screening require completion of the initial test and follow-up colonoscopy (FU-COL) when positive. Health facilities that employ the fecal immunochemical test (FIT) for CRC screening may leverage patient navigation and/or other support interventions to increase FIT and FU-COL adherence. The objective of this study was to assess the effect of these interventions on both FIT adherence and FU-COL adherence within a year at Federally Qualified Health Centers (FQHCs), Safety-Net Facilities (SNFs), Rural Health Clinics (RHCs), and Indian Health Service (IHS) facilities.

Methods: We searched only PubMed, EMBASE, and reference lists related to those articles to identify studies describing CRC screening test adherence. We included US-based, English-language manuscripts published from 1/1/2013 to 11/10/2023 and abstracts from 1/1/2020 to 11/10/2023. We excluded high-risk populations and studies describing population-based adherence. A random effects model was used to calculate the adherence rates for FIT and FU-COL after a positive FIT.

Results: From review of 5,761 unique titles/abstracts, we included 38 FIT and 9 FU-COL adherence studies. We identified 16 and 12 individual interventions for FIT and FU-COL, respectively, which were implemented in 405 and 40 combinations, respectively. The most common interventions for FIT were postal communication recommending screening (13.8%), provision of test instructions (13.6%), CRC education (12.6%), and mailed FIT (11.9%). The most common intervention for FU-COL was scheduling support (20%). Overall, FIT adherence was 35.7% (95% CI: 30.1-41.4) and was higher among those receiving any intervention compared to the usual care (39.4% vs. 26.1%, p=0.033). Overall FU-COL adherence after a positive FIT was 46.6% (95% CI: 41.1-52.1) and was numerically higher with intervention compared to usual care (52.0% vs. 45.3%, p=0.39). Table 1 shows adherence by facility type.

Discussion: Even with navigation and/or other support interventions, FIT adherence and FU-COL after a positive FIT are suboptimal. Unequal access to FU-COL may contribute to disparities across health system types, with low adherence in resource-limited settings. These findings should be informative to CRC screening program decision-makers when considering the balance of resource investment vs. achievable benefits from FIT-based strategies.


Figure: Table 1. FIT and follow-up colonoscopy adherence rates with and without intervention by facility type

Disclosures:
Xiting Cao: Exact Sciences – Employee.
Vahab Vahdat: Exact Sciences – Employee.
Heather A. Johnson: Exact Science – Employee.
Gina Thompson: Exact Sciences – Employee.
Joyce Kong indicated no relevant financial relationships.
Irem Betül Koçak: Exact Sciences – Independent Contractor.
Carol Kirshner: Exact Sciences – Independent Contractor.
A. Burak Ozbay: Exact Sciences – Employee.
Thomas Imperiale: Cook Medical – Consultant. Exact Sciences – Advisor or Review Panel Member, Consultant. Exact Sciences Corp – Grant/Research Support.
Mohammad Dehghani: Exact Sciences – Advisor or Review Panel Member, Consultant. Exact Sciences – Consultant.
Michael Dore indicated no relevant financial relationships.
Portia Zaire indicated no relevant financial relationships.
A. Mark Fendrick: AbbVie – Consultant. Agency for Healthcare Research and Quality – Grant/Research Support. Amgen – Consultant. Arnold Ventures – Grant/Research Support. Centers for Medicare and Medicaid Services. – Grant/Research Support. Centivo – Consultant. Community Oncology Association – Consultant. Covered California – Consultant. EmblemHealth – Consultant. Exact Sciences – Consultant. Freedman Health – Consultant. Gary and Mary West Health Policy Center – Grant/Research Support. GRAIL – Consultant. Harvard University – Consultant. Health & Wellness Innovations – Consultant. Health at Scale Technologies – Consultant. MedZed – Consultant. National Pharmaceutical Council – Grant/Research Support. Patient-Centered Outcomes Research Institute – Grant/Research Support. Penguin Pay – Consultant. Pharmaceutical Research and Manufacturers of America – Grant/Research Support. Risalto – Consultant. Robert Wood Johnson Foundation – Grant/Research Support. Sempre Health – Consultant. State of Michigan – Grant/Research Support. State of Minnesota – Consultant. U.S. Department of Defense – Consultant. Virginia Center for Health Innovation – Consultant. Wellthy – Consultant. Zansors – Consultant.
Paul J. Limburg: Exact Sciences – Employee.

Xiting Cao, PhD¹, Vahab Vahdat, PhD¹, Heather A. Johnson, MLIS¹, Gina Thompson, PhD¹, Joyce Kong, PharmD², Irem Betül Koçak, PhD³, Carol Kirshner, MS⁴, A. Burak Ozbay, PhD¹, Thomas Imperiale, MD⁵, Mohammad Dehghani, PhD⁶, Michael Dore, MD⁷, Portia Zaire, PhD⁸, A. Mark Fendrick, MD⁸, Paul J. Limburg, MD¹. P4808 - FIT-based Colorectal Cancer Screening Completion Rates (Initial Test and Follow-up Colonoscopy) by Health Facility Type: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.