Study lends support to targeted interventions in erasing cancer screening disparities

Being poor raises the risk of dying from cancer considerably for many reasons, not the least of which is the disparity in cancer screening rates between rich and poor. A new study appearing in JAMA Internal Medicine adds research support to the importance of targeted interventions in erasing such disparities.

The study, which was supported by the Agency for Healthcare Research and Quality (AHRQ), was conducted in Chicago with 450 community health center patients who had previously taken a fecal immunochemical tests (FIT) at home to look for signs of colon cancer. Home fecal occult blood testing, like FIT, overcomes some of the cost and access barriers to colonoscopy for poor patients without insurance, but it must be repeated annually to be effective and previous research had shown that patient compliance with annual testing was low.

The study participants were primarily women (72 percent) and most were Latino (87 percent). Most also stated that their primary language was Spanish (87 percent) and that they were uninsured (77 percent).

The group was divided into a usual care group and an intervention group, and then the two groups were compared. Interventions for patients in the usual care group included computerized reminders, standing orders for medical assistants to give patients home FIT kits and clinician feedback on colorectal cancer screening rates. The intervention group received the usual care, plus a mailed reminder letter, a free FIT with low-literacy instructions, and a postage-paid return envelope. In addition, they got an automated telephone and text message reminding them that they were due for screening and that a FIT was being mailed to them. Patients who did not return the FIT within two weeks then got an automated telephone and text reminder and personal telephone outreach by a colorectal cancer screening navigator after three months.

Not surprisingly, the intervention group had much higher rates of completing screening within six months of being due for a screening. The intervention group’s screening rate was 82.2 percent compared to the 37.3 percent rate for the usual care group. However, the researchers also looked at how many interventions and what kind worked in getting the patients in the intervention group to take action and found that most completed the screening just with mailed and automated phone/text reminders. Only 8.4 percent needed to personal telephone outreach intervention before they would complete the screening. This means, the researchers concluded, that healthcare providers might be able to erase some cancer screening disparities in the poor using relatively low-cost automated interventions using health information technology.