UT Southwestern Medical Center Dallas, TX, United States
Maryann Osayande, MD1, Kerry B. Dunbar, MD, PhD2, Myles Brewington, BS3, Haekyung Jeon-Slaughter, PhD4, Divya Bhatt, MD5 1UT Southwestern Medical Center, Dallas, TX; 2University of Texas Southwestern Medical Center at Dallas/Dallas VA Medical Center, Dallas, TX; 3North Texas Dallas VA Hospital, Dallas, TX; 4VA North Texas Health Care Center/University of Texas Southwestern Medical Center, Dallas, TX; 5University of Texas Southwestern Medical Center at Dallas/North Texas Dallas VA Hospital, Dallas, TX
Introduction: Fecal immunohistochemical testing (FIT) is an inexpensive test widely used for colorectal cancer (CRC) screening. We sought to determine the proportion of VA North Texas Health Care System (VANTHCS) veterans who completed colonoscopy after abnormal FIT, and to identify any barriers.
Methods: A retrospective chart review of 2824 veterans with abnormal FIT from 2016 to 2019 was performed. Exclusion criteria were age< 40 or >85 years, inflammatory bowel disease (IBD), CRC, family history of CRC, or if FIT was obtained for non-screening purposes. Time to colonoscopy (< 90 days, >90 days), age, sex, ethnicity, BMI, smoking, mobility, distance from VANTHCS, and Charlson Comorbidity Index (CCI) were determined. Reasons for refusing or delaying colonoscopy were collected. Veterans who completed colonoscopy within 90 days (VCC) were compared to those who completed colonoscopy after 90 days or never completed colonoscopy (VCD). Logistic regression, Mantel-Haenszel Chi-square tests, and two-sided t-tests were used to compare the groups.
Results: Of 2824 veterans with abnormal FIT, 1560 met inclusion criteria (94.7% male, 68.7% white, mean age 64.5 years). 968 veterans (62.1%) had a colonoscopy after abnormal FIT. Of these, 564 (58.3%) completed colonoscopy within 90 days and 404 (41.7%) after 90 days. 13 (3.2%) had a delayed complete colonoscopy due to poor bowel preparation. 560 patients did not complete colonoscopy. 119 veterans (21.2%) had comorbidities that precluded colonoscopy, and 22 (3.9%) had a recent negative colonoscopy. The largest barriers to care were refusal or no-show (250, 44.6%), transportation issues (83, 14.8%), and inability to contact veteran (82, 14.6%). VCD were older, had a higher CCI (p=0.006), and poor mobility (p=0.025) compared to VCC. Age, sex, ethnicity, BMI, smoking, and distance from VA were not significantly different between VCC and VCD.
Discussion: Of veterans with abnormal FIT tests, 45.5% were ordered for indications other than screening or before CRC screening was due. Diagnostic colonoscopy was completed in 62.1% of veterans with abnormal FIT; 58% within 90 days. 44% of veterans who did not undergo diagnostic colonoscopy refused or no-showed. Increasing age, higher CCI, and poor mobility were significantly associated with VCD. Other common barriers were transportation and veteran scheduling issues. Implementing patient education and navigation programs may improve veteran health by overcoming these barriers.
Disclosures: Maryann Osayande indicated no relevant financial relationships. Kerry Dunbar indicated no relevant financial relationships. Myles Brewington indicated no relevant financial relationships. Haekyung Jeon-Slaughter indicated no relevant financial relationships. Divya Bhatt indicated no relevant financial relationships.
Maryann Osayande, MD1, Kerry B. Dunbar, MD, PhD2, Myles Brewington, BS3, Haekyung Jeon-Slaughter, PhD4, Divya Bhatt, MD5. P2362 - Assessing Colonoscopy Completion After Abnormal Fecal Immunochemical Test: A Retrospective Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
