Es wurden die über 90% uptake für ProColon auch in dieser Studie nochmals bestätigt!
The availability of mSEPT9 screening in MUP unwilling or unable to complete FIT or colonoscopy led to a marked increase in screening uptake when compared to years prior, where FIT was the only screening modality offered at the health fairs. For eligible patients, the rate of testing increased from 12.6% completing testing with FIT the previous year to 93.5% with the blood test. Although navigation to colonoscopy was offered, it was not a comparator in the study as we had no prior data, and. In our health-fair setting, most patients are uninsured or underinsured, and thus experience great difficulty accessing colonoscopy. The introduction of a novel approach to CRC screening (blood-based testing) when compared to FIT has proven to be well-received by our MUP, likely as a result of convenience and ease of testing. In this study, we demonstrate that tests performed same-day at health fairs are likely to have higher uptake than those tests that are less accessible to these populations. In the health fair setting, patients have been accustomed to providing blood samples for other screening tests, and it is likely that the execution of blood-based CRC testing is more in line with a patients expectations of medical care than is sample acquisition for stool-based testing. It is probable that the inconvenience posed by completing and returning a FIT also plays a role in patient preference.
These findings are in line with previous studies on blood-based testing. In a cross-sectional survey of 100 participants, blood-based testing was ranked as a first or second choice of screening in 91% when compared with colonoscopy, sigmoidoscopy, or stool testing. Participants preferred mSEPT9 over FIT and/or colonoscopy due to convenience (60%), low cost (47%), low level of discomfort (30%), lack of required bowel preparation (28%), and more frequent screening intervals (18%)20. Further data will be needed in order to better understand patient choice in the health fair setting when selecting among CRC screening tests.
The mSEPT9 blood test had similar characteristics as previously reported in studies where patients had access to care; however, the number of patients requiring diagnostic colonoscopy for positive mSEPT9 is worthy of consideration. Despite patient agreement to participate in accessible screening modalities, barriers to further care pose additional complications. The lack of access to follow-up services for those with positive mSEPT9 screening has proven to be a challenge (particularly in light of the high test positivity rate), as has the ability to routinely remain in contact with this population, primarily due to inconsistent addresses and phone access. However, incorporation of blood-based testing in resource-poor settings may facilitate identification of individuals who would benefit most from colonoscopy and can be greatly beneficial when paired with a patient navigation program that can facilitate coordination of needed care. Many of the patients who received follow up colonoscopy after positive mSEPT9 screen were able to do so because of the assistance of patient navigation to facilitate access to financial assistance within the county safety net hospital system.
By providing mSEPT9 as an alternative method of CRC screening in MUP in South Florida, there was increased uptake of testing despite the underlying socio-economic challenges that this population faces. Lack of adequate uptake of subsequent diagnostic colonoscopy in those patients testing positive is concerning and points to the need for improved navigation coupled with the need for easier access to colonoscopy. In those who received diagnostic colonoscopy, lack of high-risk lesions is difficult to interpret until more are completed: a challenge with our transient and demographically-varied MUP. While statistically non-inferior to FIT with respect to sensitivity, specificity is ~ 80% compared to ~ 97% for FIT21,22. Future work will be aimed at longer follow up of patients, larger populations, and quantification of patient acceptability. In addition, an ongoing post approval study is focused on measuring repeat testing uptake over time for patients with negative test results.
One limitation of the study was that testing was provided free of charge to all participants, which would remove a cost barrier for participants. In this regard, the results may not be generalizable to the population. However, this is a typical of provision of services in a health care setting, and by way of comparison, FIT testing was also offered at no cost. On this basis, the impact on test uptake remains valid. As noted above, a second limitation was the lack of easy availability of screening colonoscopy. Recognizing this challenge, we simply reported the absence of colonoscopy screening and make no comparison claims with this method.
From a public health perspective, the increased uptake of screening is notable, though importantly, we recognize the concern that comes from screening patients who are unable to access a diagnostic colonoscopy following a positive screening test. To some degree, inability to access colonoscopy is a complication that may deter future use; however, given the variability among MUP, its difficult to determine ease of colonoscopy access at the time of screening. Furthermore, the lack of access to follow-up colonoscopy is a challenge in common for all non-invasive screening tests. The cost of testing represents a second public health challenge. Testing by FIT remains the least costly approach to screening, and there is and increased cost impact of blood-based testing, similar to other non-invasive methods such as stool DNA23. However, blood-based testing has been shown to be a cost-effective approach for screening, given an observed increase in adherence to testing.24
Modeling studies have shown that adherence to screening is a key driver in the success of screening programs10. Our assessment of blood-based testing has clearly demonstrated that this alternative modality has the potential to improve adherence to screening in MUP, overcoming the barriers associated with the other screening methods. Combining blood-based screening with navigation for patients with positive results may be an appropriate model to improve MUP CRC screening rates.
|
Thread abonnieren
