BACKGROUND & AIMS: Reports of mailed fecal immunochemical test (FIT) outreach effectiveness over time are minimal. We aimed to better evaluate a mailed FIT program with longitudinal metrics.METHODS: A total of 10,771 patients aged 50-75 years not up-to-date (UTD) with colorectal cancer (CRC) screening were randomized to intervention or usual care. The intervention arm received an advanced notification call and informational postcard prior to a mailed FIT. Usual care was at the discretion of the primary care provider. Patients were followed for up to 2.5 years. The primary outcome was the difference in cumulative proportion of completed FIT screening between arms. Screening was further examined with the proportion of time UTD, consistency of adherence, and frequency of abnormal FIT.RESULTS: The cumulative proportion of FIT completion was higher in the outreach intervention (73.2% vs. 55.1%, p<0.001). The proportion of time covered by screening was higher in the intervention group (46.8% vs. 27.3%, Delta19.6%, 95% CI 18.2%-20.9%). Patients assigned to FIT outreach were more likely to consistently complete FITs (2 completed of 2 offered) (50.1% vs. 21.8%, p<0.001). However, for patients who did not complete the FIT during the first cycle, only 17.1% completed a FIT during the second outreach cycle. The number and overall proportion of abnormal FIT was significantly higher in the outreach intervention (6.9% Outreach vs. 4.1% Usual Care, p<0.01).CONCLUSIONS: Organized mailed FIT outreach significantly increased CRC screening over multiple years in this safety-net health system. While mailing was overall effective, the effect was modest in patients who did not complete FIT in first cycle of intervention. (ClincialTrials.gov, NCT02613260).
View details for DOI 10.1016/j.cgh.2021.07.022
View details for PubMedID 34280552