ASPO Abstracts
Multimorbidity and colorectal cancer screening in the Strategies and Opportunities to Stop Colorectal Cancer (STOP CRC) pragmatic trial
Category: Early Detection & Risk Prediction
Conference Year: 2019
Abstract Body:
Purpose: Chronic disease burden can influence patients’ likelihood of participating in cancer screening, including colorectal cancer (CRC) screening. The literature is mixed about how best to measure chronic conditions (e.g., counts of conditions vs severity) and their impact on cancer screening participation. Using data from a large pragmatic trial of CRC screening in federally qualified health centers (STOP CRC), we applied two comorbidity indices to assess the association between chronic conditions and receipt of fecal immunochemical testing (FIT).Methods: Participating STOP CRC clinics (n = 26) were randomized to receive either training and facilitation for an electronic-health record enabled mailed FIT outreach program or usual care. Patients eligible for the STOP CRC intervention (n = 62,155) were aged 50-74 and overdue for CRC screening and had a clinic visit in the past year. Patients’ diagnoses codes in the past year were used to calculate patient-level chronic disease scores using two measures: the Charlson Comorbidity Index (CCI) and the Chronic Illness and Disability Payment System (CDPS). We used logistic regression to assess the associations between the presence of chronic conditions and receipt of a FIT order and completion of a FIT, adjusting for demographic characteristics and health care utilization variables. Results: A total of 12,706 patients completed a FIT within 3 months of order , among 35,624 patients who received a FIT order (12,828 patients reached though intervention-specific activities, 22,796 reached through usual care only) . Patients with CCI of 3, 4, or ≥5 had lower odds of FIT completion than patients with a CCI of 0 (each OR ≈ 0.7, p<0.05). Diagnoses of HIV (0.2% prevalence) or substance abuse disorder (11% prevalence) were associated with lack of FIT completion (OR = 0.7 and 0.8, respectively; p<0.05). All associations persisted after adjustment for number of clinic visits and were not altered by other adjustments.Conclusions: Our findings from two chronic disease indices suggest that federally qualified health center patients who have multiple chronic conditions or who have a diagnosis of HIV or substance abuse disorders have a lower likelihood of completing a FIT than patients without these conditions.
Keywords: colorectal cancer screening, fecal immunochemical test, multimorbidity