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Mailing of the Faecal Occult Blood Test (FOBT) to increase compliance to colorectal cancer screening and to reduce costs

ABSTRACT: Study hypothesis: European Commission Guidelines on cancer prevention recommend to the member states the implementation of colorectal cancer screening programmes based on the Faecal Occult Blood Test (FOBT) every two years in the population 50-70 years old. In Italy, colorectal cancer screening is affected by low compliance. Furthermore the front office activities to give the faecal sampler to the participants are time and cost consuming. A direct mailing strategy of the faecal sampler could increase compliance and could reduce the resource consumption of the front office activities. Primary outcome(s): Compliance to screening at 60 days after mailing (of the FOBT or of the letter).

DISEASE(S): Compliance To Colorectal Cancer Screening

PROVIDER: 2408138 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Study hypothesis: The efficacy of colorectal cancer screening (CRCS) using faecal occult blood test (FOBT) in reducing colorectal cancer (CRC) mortality in a population at generic risk, has been shown in several large randomized trials. The screening programs need to contact the whole target population and involve as many people as possible in order to be actually effective. The scientific literature about the reasons for non-compliance have generated few definitive operational recommendations. Two types of FOBT are now available: the Guaiac and the Immunochemical test. The sensitivity and specificity of the two tests are similar and do not clearly indicate which one is better for screening. The price of the immunochemical test is actually about 1.5 times higher than the Guaiac, but there are no data about the costs per person screened. The Guaiac test recommends three different evacuations, and requires the patient to store the samples, and follow dietary restrictions. The immunochemical test is recommended on a single evacuation and does not require dietary restrictions. The discomfort and embarrassment of faecal sampling and the dietary restrictions have been hypothesized to be determinants of non-compliance. This background may determine lower compliance to the Guaiac test. Several guidelines for screening programme implementation recommend the involvement of general practitioners (GP) and family practitioners (FP); nevertheless the role of the GPs and FPs varies between countries and health service organizations, making this recommendation hard to implement. The Agency for Public Health of Lazio, Italy, decided to design a trial phase in order to plan an evidence-based implementation of the CRCS program. The aim of this approach is to guarantee that the efficacy of CRCS can be translated to effectiveness in a public health intervention. The screening strategy adopted was: yearly FOB testing for 5074 year olds and, for positives, colonoscopy. A special focus was how to obtain a high compliance to screening; the topics studied were: GPs attitudes and practices, type of FOBT, test provider, and the individual reasons. Studies included: a survey, a randomized factorial trial nested in the survey, and a casecontrol study nested in the trial. Primary outcome(s): Compliance to screening: (number of returned faeces samples)/(total number of invited subjects)

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Mailing of the Faecal Occult Blood Test (FOBT) to increase compliance to colorectal cancer screening and to reduce costs

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