An iPad application incorporating a decision aid for colorectal cancer screening may increase screening rates compared to usual care, a recent study found.
The Mobile Patient Technology for Health–CRC (mPATH-CRC) app educates patients about their colorectal cancer screening options, allows them to order their preferred test, and sends automated follow-up messages. At six community-based primary care practices in North Carolina, researchers randomly assigned 450 participants ages 50 to 74 years who were due for colorectal cancer screening to a mPATH-CRC group (n=223) or a control group (n=227) that received only a brief CDC video about diet and exercise.
The primary outcome was chart-verified completion of a colorectal cancer screening test within 24 weeks. Secondary outcomes were patients' ability to state their screening preference and intention to receive screening, as well as whether they had screening discussions with their clinician and screening tests ordered. Results were published online on March 13 by Annals of Internal Medicine.
Patients in the intervention group had double the screening rates as those in the control group (30% [67 of 223 patients] vs. 15% [34 of 227 patients]; odds ratio, 2.5 [95% CI, 1.6 to 4.0]). Compared to the control group, more of the participants in the intervention group could state a screening preference, planned to be screened within six months, discussed screening with their clinician, and had a screening test ordered. The study authors noted limitations, such as how the study was conducted in a single health system.
An accompanying editorial noted that despite the trial's success, it missed opportunities that could have made the intervention even more groundbreaking. First, researchers introduced the intervention in the context of a clinic visit, even though it did not require such a setting. The editorialists also noted that the study's consent requirements limited its population to those who were motivated to enter a clinical trial. “Why couldn't eligible patients simply have been randomly assigned to usual care or this new protocol to see what happened without requiring anyone to opt in (or not opt out) in the first place?” they wrote.
In a second study, also published online on March 13 by Annals of Internal Medicine, colonoscopy was associated with a 61% reduction in colorectal cancer mortality among U.S. veterans, although the benefit was greater for left-sided cancer (72%) than right-sided cancer (46%).
Researchers used Veterans Affairs–Medicare administrative data to conduct the case-control study. Case-patients (n=4,964) were ages 52 years and older and were diagnosed with colorectal cancer between 2002 and 2008 and died of the disease by the end of 2010. Each case-patient was matched to four control patients (n=19,856) without prior colorectal cancer on the basis of age, sex, and facility. Researchers calculated odds ratios for colorectal cancer mortality based on exposure to colonoscopy (between 1997 and six months before colorectal cancer diagnosis or a corresponding index date in control patients), adjusting for race, comorbidities, selected chronic conditions, NSAID use, and family history of colorectal cancer.
Case-patients were significantly less likely than control patients to have had any colonoscopy (odds ratio [OR], 0.39; 95% CI, 0.35 to 0.43). Colonoscopy was associated with reduced odds of mortality for left-sided cancer (OR, 0.28; 95% CI, 0.24 to 0.32) and right-sided cancer (OR, 0.54; 95% CI, 0.47 to 0.63). In a subgroup analysis that looked at colonoscopy indication, screening colonoscopy was also associated with reduced adjusted odds of colorectal cancer mortality (overall OR, 0.30 [95% CI, 0.24 to 0.38]; left-sided OR, 0.20 [95% CI, 0.14 to 0.27]; right-sided OR, 0.48 [95% CI, 0.35 to 0.66]).
The study authors noted limitations, such as unmeasured potentially confounding factors, including body mass index and physical exercise. They added that the subgroup analysis of colonoscopy indication was limited by a relatively small proportion of screening procedures (20.6%).