A pragmatic randomized trial of mailed fecal immunochemical testing to increase colorectal cancer screening among low-income and minoritized populations

Maria Elena Martinez; Scott Roesch; Valesca Largaespada; Sheila F Castañeda; Jesse N Nodora; Borsika A Rabin; Jennifer Covin; Kristine Ortwine; Yesenia Preciado-Hidalgo; Nicole Howard; James Schultz; Nannette Stamm; Daniel Ramirez; Michael T Halpern; Samir Gupta

doi:10.1002/cncr.35369

A pragmatic randomized trial of mailed fecal immunochemical testing to increase colorectal cancer screening among low-income and minoritized populations

Cancer. 2024 May 25. doi: 10.1002/cncr.35369. Online ahead of print.

Authors

Maria Elena Martinez^{1

2}, Scott Roesch³, Valesca Largaespada¹, Sheila F Castañeda³, Jesse N Nodora^{1

4}, Borsika A Rabin⁵, Jennifer Covin⁶, Kristine Ortwine⁷, Yesenia Preciado-Hidalgo⁶, Nicole Howard⁶, James Schultz⁸, Nannette Stamm⁹, Daniel Ramirez¹⁰, Michael T Halpern¹¹, Samir Gupta^{1

12}

Affiliations

¹ Moores Cancer Center, University of California San Diego, La Jolla, California, USA.
² Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA.
³ Department of Psychology, San Diego State University, San Diego, California, USA.
⁴ Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA.
⁵ Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla, California, USA.
⁶ Health Quality Partners of Southern California, San Diego, California, USA.
⁷ Integrated Health Partners of Southern California, San Diego, California, USA.
⁸ Neighborhood Healthcare, Escondido, California, USA.
⁹ Vista Community Clinic, Vista, California, USA.
¹⁰ San Ysidro Health, San Ysidro, California, USA.
¹¹ National Cancer Institute, Rockville, Maryland, USA.
¹² Veterans Affairs San Diego Healthcare System, San Diego, California, USA.

PMID: 38795024
DOI: 10.1002/cncr.35369

Abstract

Background: Colorectal cancer (CRC) screening is underused, particularly among low-income and minoritized populations, for whom the coronavirus disease 2019 (COVID-19) pandemic has challenged progress in achieving equity.

Methods: A hub-and-spoke model was used. The hub was a nonacademic organization and the spokes were three community health center (CHC) systems overseeing numerous clinic sites. Via a cluster-randomized trial design, nine clinic sites were randomized to intervention and 16 clinic sites were randomized to usual care. Patient-level interventions included invitation letters, mailed fecal immunochemical tests (FITs), and call/text-based reminders. Year 1 intervention impact, which took place during the COVID-19 pandemic, was assessed as the proportion completing screening among individuals not up to date at baseline, which compared intervention and nonintervention clinics accounting for intraclinic cluster variation; confidence intervals (CIs) around differences not including 0 were interpreted as statistically significant.

Results: Among 26,736 patients who met eligibility criteria, approximately 58% were female, 55% were Hispanic individuals, and 44% were Spanish speaking. The proportion completing screening was 11.5 percentage points (ppts) (95% CI, 6.1-16.9 ppts) higher in intervention versus usual care clinics. Variation in differences between intervention and usual care clinics was observed by sex (12.6 ppts [95% CI, 7.2-18.0 ppts] for females; 8.8 ppts [95% CI, 4.7-13.9 ppts] for males) and by racial and ethnic group (13.8 ppts [95% CI, 7.0-20.6 ppts] for Hispanic individuals; 13.0 ppts [95% CI, 3.6-22.4 ppts] for Asian individuals; 11.3 ppts [95% CI, 5.8-16.8 ppts] for non-Hispanic White individuals; 6.1 ppts [95% CI, 0.8-10.4 ppts] for Black individuals).

Conclusions: A regional mailed FIT intervention was effective for increasing CRC screening rates across CHC systems serving diverse, low-income populations.

Keywords: colorectal cancer screening; community health centers; disparities; fecal immunochemical test; minoritized populations.

Abstract

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