Mass-Mailed Stool Tests Helped Improve Odds of Adherence, CRC Test Return

Screening for colorectal cancer (CRC) could be made easier through mailing older adults on Medicare Advantage a multitarget stool DNA (mt-sDNA) test for them to complete, according to a study published in Journal of Primary Care & Community Health.1 Digital outreach also improved adherence in this population.

Improving outcomes in CRC, the second-leading cause of deaths related to cancer in the US,2 relies on early detection. The US Preventive Services Task Force recommends that all adults aged 45 to 75 years be screened for CRC, which can include both colonoscopy and stool tests like the fecal immunochemical test (FIT) and mt-sDNA. Implementing a gap closure program that mails tests to older adults could help with improving screening numbers by encouraging those who would not get screening by themselves. This study aimed to evaluate the adherence to 1 mt-sDNA test in patients on Medicare Advantage who received a mailed test.

Data from March 1, 2023, to June 30, 2023, that were collected from laboratory data from the test manufacturer and from the order placed by the Medicare Advantage Insurance Plan (MAIP) were used for this study. All participants were aged 45 to 85 years and were enrolled in MAIP. Patients were excluded if they were not covered by a Medicare Advantage plan or if there were less than 270 days between the date of the shipment and the date of data being pulled.

Adherence to screening for CRC increased when mailing tests to patients aged 45 to 85 years covered by Medicare Advantage. | Image credit: luchschenF - stock.adobe.com

The adherence rate for the mt-sDNA was the primary outcome of the study, and the authors defined this as completing, shipping, and receiving the completed test within 270 days of shipment. The time to test return was the secondary outcome. Demographic data were collected from each patient.

There were samples from 3201 patients included in the study, with 86.6% of patients being aged 65 to 75 years and 58.7% of them being female. A total of 71.2% of the patients lived in metropolitan areas. Outreach methods included partial digital through texting (61.8%) and nondigital (33.6%).

The mean time to test return was 25.5 days and the overall adherence rate was 49.4%, with the highest adherence coming from those aged 65 to 75 years (50.8%) compared with those aged 45 to 64 years (39.9%) and 76 to 85 years (41.7%). Patients with no digital outreach had a lower adherence overall (43.4%) compared with those who had email only (57.9%), text message only (51.1%), or both email and text (75.9%). Patients in a small town had the highest adherence (55.3%) compared with micropolitan areas (52.6%), rural areas (46.9%), and metropolitan areas (48.2%).

Patients aged 65 to 75 years were more likely to return their test compared with patients aged 45 to 64 years (OR, 1.59; 95% CI, 1.27-1.98). The odds of a test return also increased if the patient was living in a small town compared with a metropolitan area (OR, 1.43; 95% CI, 1.13-1.81).

There were some limitations to this study. Race, ethnicity, and preferred language were missing for approximately 90% of participants, and it is unknown if the insurer assessed all participants’ eligibility for testing. Also, continued adherence was not evaluated in favor of adherence to only a single test, and the data may have been skewed toward positive results due to exclusion of tests where there were less than 270 days between date of shipment and the date the data were pulled. This study may not be generalizable to those who received point-of-care testing. Follow-up colonoscopy was not evaluated for adherence.

“Mass-mailing screening strategies have the potential to improve CRC screening rate by reaching individuals who may otherwise not interact with the health care system,” concluded the authors of the study. “Future studies evaluating follow-up testing and treatments among patients who tested positive with mass-mailed mt-sDNA tests are warranted.”

References

1. Greene M, Pew T, Le Q, et al. Member adherence to a health insurer-sponsored gap closure program using multi-target stool DNA test for colorectal cancer screening. J Prim Care Community Health. Published online December 10, 2024. doi:10.1177/21501319241305958

2. Colorectal cancer: key facts. World Health Organization. July 11, 2023. Accessed December 10, 2024. https://www.who.int/news-room/fact-sheets/detail/colorectal-cancer