C0177 - Positive Fecal Immunochemical Testing (+FIT) in the COVID-19 Pandemic: Resilient Systems in Troubled Times

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Wesley Wright, MD

University of South Florida Morsani College of Medicine
Tampa, Florida

Wesley Wright, MD¹, Molly Orlick, ², Judah Kreinbrook, BS², Ambuj Kumar, MD, MPH¹, Brijesh Patel, MD³
¹University of South Florida Morsani College of Medicine, Tampa, FL; ²Tampa VA Clinical Research and Education Center, Tampa, FL; ³James A. Haley VA Hospital, Tampa, FL

Introduction: Colorectal cancer screening via colonoscopy decreased significantly due to the COVID-19 pandemic, with mail-out fecal immunochemical testing (FIT) initiated to maintain screening. Due to concerns surrounding +FIT follow-up we added FIT navigation (FITNav) via a nurse practitioner who followed +FIT to colonoscopy in August 2020. After implementation we noted little improvement in colonoscopy < 180 days compliance. This prompted a quality improvement (QI) project which resulted in a centralized database. Here we report a subgroup analysis to answer the question: were there racial disparities in +FIT follow-up prior to FITNav implementation?

Methods: We queried +FIT from patients 45-85 y/o from 3/1/2019/20-9/3/2019/20, defined as the pre-pandemic and pandemic cohorts respectively. Patients with dementia & >65 y/o, diagnostic/inpatient FIT, or provider-initiated cancellation of colonoscopy due to comorbidities were excluded. Chart review retrieved FIT indications, patient/navigator notification time, GI consult placement time, and colonoscopy. We added Area deprivation index (ADI) to evaluate neighborhood-level disparities. An adjusted and unadjusted cox regression model was used to evaluate colonoscopy < 180 days between pandemic/pre-pandemic, summarizing via hazard ratios (HR) and 95% confidence intervals (CI).

Results: There were 121 & 103 +FIT meeting criteria in the pandemic & pre-pandemic respectively. Demographics (age, marital status, race, ADI, and sex) between periods showed no statistically significant differences. Proportion receiving colonoscopy < 180 days in the pre-pandemic and pandemic periods was 53.7% and 60.2% (unadjusted HR 1.08, 95% CI 0.76-1.54, p=0.676). This remained insignificant when adjusted for race/ethnicity, marital status, priority group, ADI, time to notification, and age (adjusted HR 1.03, 95% CI 0.71-1.50, p=0.872). While Black, non-Hispanic individuals had a univariate HR of 2.09 (95% CI 1.33-3.29 p=0.001), multivariate HR was 1.59 (95% CI 0.92-2.74, p=0.093). ADI did not show a statistically significant difference upon univariate or multivariate analysis.

Discussion: No findings were present which suggested new or exacerbated racial disparities. Additionally, neighborhood-level disparities did not modify these findings; however, this evaluation is limited by sample size.

Figure: Kaplan-Meier Plot Colonoscopy in <180 days Pre-pandemic vs. Pandemic

y-axis= Probability

Blue= Pre-pandemic
Red= Pandemic

		Total	HR (univariable)*	HR (multivariable)*
Cohort	Pre-pandemic	114 (53%)
	Pandemic	101 (47%)	1.08 (0.76-1.54, p=0.676)	1.03 (0.71-1.50, p=0.872)
Race/Ethnicity	Caucasian/ Non-Hispanic	162 (75%)
	Black/ Non-Hispanic	26 (12%)	2.09 (1.33-3.29, p=0.001)	1.59 (0.92-2.74, p=0.093)
	Hispanic	15 (7%)	0.80 (0.37-1.73, p=0.573)	0.74 (0.33-1.64, p=0.454)
	Others	6 (4%)	0.74 (0.33-1.64, p=0.454)	0.82 (0.25-2.67, p=0.741)
	Declined/Unknown	6 (4%)	0.55 (0.13-2.22, p=0.398)	0.47 (0.11-1.98, p=0.304)
Marital Status	Married	113 (52.6%)
	Not Married	102 (47.4%)	0.68 (0.47-0.97, p=0.033)	0.74 (0.51-1.10, p=0.136)
ADI National Rank	Mean (SD)	64.1 (22.7)	0.99 (0.99-1.00, p=0.127)	1.00 (0.99-1.01, p=0.441)
Days to FIT Notification	Mean (SD)	9.0 (12.7)	0.98 (0.96-1.01, p=0.141)	0.98 (0.95-1.01, p=0.131)
Age	Mean (SD)	66.4 (8.4)	0.98 (0.96-1.00, p=0.035)	0.98 (0.96-1.01, p=0.133)

Table: Hazard Ratios Obtained on Cox Regression for Pre-pandemic/Pandemic Cohorts

*Blank Cells represent reference groups

Disclosures:

Wesley Wright indicated no relevant financial relationships.

Molly Orlick indicated no relevant financial relationships.

Judah Kreinbrook indicated no relevant financial relationships.

Ambuj Kumar indicated no relevant financial relationships.

Brijesh Patel indicated no relevant financial relationships.

Wesley Wright, MD¹, Molly Orlick, ², Judah Kreinbrook, BS², Ambuj Kumar, MD, MPH¹, Brijesh Patel, MD³. C0177 - Positive Fecal Immunochemical Testing (+FIT) in the COVID-19 Pandemic: Resilient Systems in Troubled Times, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.