Registry Data Expand Colorectal Cancer Screening in Louisiana
Louisiana Cancer Registry
Data from the Louisiana Tumor Registry have long indicated high incidence and death rates for colorectal cancer among men and women in all racial groups in Louisiana. In 2008, representatives from the School of Public Health at the Louisiana State University Health Sciences Center presented these data to state legislators in an effort to highlight the seriousness of this disease. The presentation showed that an investment of $1.5 million per year for screening uninsured and underinsured people for colorectal cancer would save almost $19 million in cancer treatment costs over three years.
As a result of this meeting, the Louisiana Comprehensive Cancer Control Program was awarded funding to work with state partners to establish the Louisiana FIT Colon Program (FITCo). FITCo—a two-year, comprehensive colorectal cancer screening pilot—received $1.5 million in funding in 2008 and $350,000 in 2009. Its goal was to create a sustainable program that addresses health disparities, capacity building, screening, diagnostics, and support services related to colorectal cancer.
FITCo established a coordinated patient referral system between Federally Qualified Health Centers, the Louisiana Breast and Cervical Health Program clinics (early detection providers), and state hospitals to ensure appropriate follow-up care for patients with a positive fecal immunochemical test (FIT). In addition, nine colonoscopes and other peripheral equipment were purchased throughout the state. The purchase of this equipment was integral to the program's success.
A key component of FITCo was helping patients navigate the health care system. Health care providers were required to educate eligible patients on colorectal cancer and on how to use and return a take-home FIT. Providers also were required to track when patients received and returned the take-home FITs, to record the results of the test, and to follow up once a week with patients who had received the test but had not returned it. They also ensured that patients with positive results received appropriate follow-up care.
One notable outcome of the program was the high return rate (71%) of the take-home FITs, which was attributed to the test's ease of use and the patient support provided. Clinicians liked the higher sensitivity and specificity of the FIT chosen for the program compared with traditional fecal occult blood tests. Patients may have been more likely to return the take-home FIT because it required only two stool samples, limited stool handling, and no dietary or medicinal restrictions. Patients could mail the samples directly to the laboratory, eliminating the need for a third party and reducing lag time. Because health care providers were not required to collect stool samples and mail them to a laboratory, they had more time to recruit, educate, and navigate patients.
FITCo demonstrates that patient navigation combined with a user-friendly screening test can increase patient compliance and ultimately detect disease and reduce death associated with colorectal cancer.