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The influence of multi-morbidities on colorectal cancer screening recommendations and completion

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Abstract

Purpose

Patients’ chronic disease burden can influence the likelihood that providers will recommend cancer screening and that patients will participate in it. Using data from the STOP CRC pragmatic study, we examined associations between chronic disease burden and colorectal cancer screening recommendation and use.

Methods

Participating STOP CRC clinics (n = 26) received either usual care or training to implement a mailed fecal immunochemical test (FIT) outreach program. Selected clinic patients (n = 60,187 patients) were aged 50–74 and overdue for colorectal cancer screening. We used logistic regression to examine the associations between FIT recommendations and completion and patients’ chronic disease burden, calculated using the Charlson Comorbidity Index and the Chronic Illness and Disability Payment System.

Results

For each index, FIT recommendation odds were 8–9% higher among individuals with minimal chronic disease burden and 13–23% lower among individuals with high chronic disease burden (inverted U-shaped association). Among adults who were ordered a FIT, FIT completion odds were 20% lower for individuals with any, versus no, chronic condition and diminished with increasing disease burden (inverse linear association).

Conclusions

Analysis showed an inverted U-shaped association between patients’ chronic disease burden and providers’ recommendation of a FIT and an inverse linear association between patients’ chronic disease burden and FIT completion. ClinicalTrials.gov registration: NCT01742065

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Acknowledgments

Research reported in this publication was supported by the National Cancer Institute, Award Number UH3CA188640. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The study sponsor had no role in study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication.

Funding

Research reported in this publication was supported by the National Cancer Institute, Award Number UH3CA188640.

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Authors and Affiliations

  1. Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA

    Gloria D. Coronado, Carrie M. Nielson, Erin M. Keast & Amanda F. Petrik

  2. Center for Personalized Health, Feinstein Institute for Medical Research, New York, NY, 10022, USA

    Jerry M. Suls

Authors
  1. Gloria D. Coronado
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  2. Carrie M. Nielson
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  3. Erin M. Keast
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  4. Amanda F. Petrik
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Corresponding author

Correspondence to Gloria D. Coronado.

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Conflict of interest

Dr. Coronado served as a co-investigator on a study funded by Epigenomics and as a principal investigator on a study funded by Quidel Corporation. Dr. Coronado also served as a scientific advisor for Exact Sciences and Guardant Health. The studies had no influence on the design, conduct, or reporting of the present study. All other authors declare that they have no conflict of interest.

Research involving Human Participants and/or Animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (The Institutional Review Board of Kaiser Permanente Northwest; ClinicalTrials.gov registration: NCT01742065) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Review Board of Kaiser Permanente Northwest approved all study activities, and participating clinics ceded human subjects review authority to this IRB.

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Informed consent was obtained from all individual participants included in the study.

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Coronado, G.D., Nielson, C.M., Keast, E.M. et al. The influence of multi-morbidities on colorectal cancer screening recommendations and completion. Cancer Causes Control 32, 555–565 (2021). https://doi.org/10.1007/s10552-021-01408-2

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  • DOI: https://doi.org/10.1007/s10552-021-01408-2

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