Colorectal cancer screening rates remain low

Investigators failed to see improvement in colorectal cancer (CRC) screening rates among patients enrolled in a managed care health plan after testing the effectiveness of a CRC screening promotion program targeting the physician organizations (POs).

According to a new study published in the November 15, 2005 issue of CANCER, a peer-reviewed journal of the American Cancer Society, screening rates remained less than 30 percent, though a few individual POs were able to increase use up to 70 percent.

Cancer screening is an important tool to improve patient survival and reduce cancer-related morbidity. Once a screening test or screening protocol is proven to be efficacious or recommended, then the next step is getting people and healthcare providers to utilize it. How to promote the screening intervention is subjected to further testing to demonstrate effective use of scarce public health resources or identify barriers to a screening intervention. Studies of various cancer-specific screening promotional campaigns have demonstrated success in highly controlled environments, such as an individual physician's office, where external research staff facilitate the screening program. Very few have demonstrated success in real-world, community environments, such as a managed care setting, without the availability of research staff.

CRC screening rates remain low, despite evidence that CRC screening, such as fecal occult blood tests, flexible sigmoidoscopy and colonoscopy, are generally effective at reducing mortality. Patricia A. Ganz, M.D. of the Jonsson Comprehensive Cancer Center in Los Angeles and colleagues evaluated a CRC screening promotion intervention that targeted the administrative structure of physician organizations in a single managed care network rather than individual physician practices. This top-down, directive-driven approach, which relied on POs to integrate provider and patient CRC screening education into their organizations, was evaluated in a randomized controlled trial.

Analysis of patient charts from the thirty-two POs that completed participation in the two-year study failed to show any interval difference in CRC screening rates between the POs that were assisted in using strategies to increase screening and the POs that did not. Despite CRC screening being reimbursable by the managed care insurance company and access to a primary care provider, only 26 percent of eligible patients actually were screened in any way for CRC. Only 29 percent of these were screened according to recommended guidelines.

Characterization of CRC screening in this setting revealed that patients who were over 60 years old, received a physical in the previous two years, or were enrolled in a PO with an integrated medical group (more organizational structure) were more likely to receive a CRC screening test.

"We failed to demonstrate an intervention effect in this study," concluded the authors. However, they were able to identify provider organization and patient characteristics, specifically, integrated medical organizations and having a regular physical examination, which future interventions should exploit.

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