Clinical Factors Associated with Adherence to the Follow-Up Examination after Positive Fecal Occult Blood Test in National Colorectal Cancer Screening

Abstract

Background: The compliance with the follow-up examination after a positive fecal occult blood test (FOBT) is lower than expected. We aimed to evaluate the adherence rate to the follow-up examination in patients with a positive FOBT and to identify the clinical factors associated with this adherence. Methods: The study population comprised adults aged ≥50 years who participated in the National Cancer Screening Program for colorectal cancer (CRC) in 2013. Compliance was defined as undergoing follow-up examination within 1 year of a positive FOBT. Results: From 214,131 individuals with a positive FOBT, 120,911 (56.5%) were in the compliance group and 93,220 (43.5%) were in the non-compliance group. On multivariate analysis, good compliance was associated with men (odds ratio (OR) = 1.12, 95% confidence interval (CI) (1.09–1.15)), younger ages (70–79 years, OR = 2.19 (2.09–2.31); 60–69 years, OR = 3.29 (3.13–3.46); 50–59 years, OR = 3.57 (3.39–3.75) vs. >80 years), previous experience of CRC screening (a negative FOBT, OR = 1.18 (1.15–1.21); a positive FOBT, OR = 2.42 (2.31–2.54)), absent previous experience of colonoscopy or barium enema (OR = 2.06 (1.99–2.13)), higher economic income (quartile, 75%, OR = 1.14 (1.11–1.17); 100%, OR = 1.22 (1.19–1.25)), current smokers (OR = 1.12 (1.09–1.15)), alcohol intake (OR = 1.03 (1.01–1.05)), active physical activity (≥3 times/week, OR = 1.13 (1.11–1.15)), depression (OR = 1.11 (1.08–1.14)), and present comorbidities (Charlson Comorbidity Index, ≥1). Conclusion: This study identified clinical factors, namely, male, younger ages, prior experience of fecal test, absent history of colonoscopy or double-contrast barium enema (DCBE) within 5 years, and high socioeconomic status to be associated with good adherence to the follow-up examination after a positive FOBT.

Colorectal Cancer screening in ambulatory healthcare service clinics in Abu Dhabi, United Arab Emirates in 2015–2016

“…A low rate of follow-up of abnormal FIT/gFOBT has been noted in different studies and different factors were attributed [ 26 – 30 ]. In our study, most of the patients were referred to a gastroenterologist, but they were not examined or counseled by the gastroenterologist.…”

“…This suggests the lack of knowledge about the importance of follow-up which can put the patient at risk of having advanced CRC and increased mortality [ 26 – 29 ]. Some of the patients’ appointments were missed or not scheduled, which can be due to a lack of communication between the patients and the healthcare system that was addressed in multiple studies [ 30 , 31 ]. A total of 12% of the patients were not informed about the positive FIT/gFOBT, which delays the timely medical intervention, reflecting the essential role of the healthcare provider to ensure follow-up [ 30 ].…”

“…Some of the patients’ appointments were missed or not scheduled, which can be due to a lack of communication between the patients and the healthcare system that was addressed in multiple studies [ 30 , 31 ]. A total of 12% of the patients were not informed about the positive FIT/gFOBT, which delays the timely medical intervention, reflecting the essential role of the healthcare provider to ensure follow-up [ 30 ]. One of the observations was repeating the FIT/ gFOBT if the result was positive, which may reflect the lack of patients’ trust in the test [ 27 ].…”

Factors affecting the rates of adherence to surveillance recommendations for incidental pancreatic cystic lesions in a large urban safety net hospital

“…A study from the National Cancer Screening Program in South Korea found that adherence rates to follow-up after a positive faecal occult blood test were associated with being a younger male of high socioeconomic status. 12 For cervical cancer screening, it has been reported that English fluency and number of years in the USA were positively associated with adherence rates. 13 Thus, it is critical for clinicians to recognise these differences, for which interventions may help reduce healthcare disparities.…”

Evaluation of Intensified Colorectal Cancer Treatment Using Model Based on Delphi Method, Fuzzy Logic, and Analytical Hierarchy Process (DFAHP)

“…In 2013, the number of patients aged below 20 suffering from colorectal cancer was 2.1 times higher than that 10 years earlier, while the number of patients aged above 85 was 3.3 times higher. (5) As a fecal occult blood test (FOBT) effectively screens colorectal cancer, (6) regular health examinations contribute to the early discovery of colorectal cancer, (7) and the immune checkpoint inhibitors should be monitored to treat metastatic colorectal cancer effectively. (8) In terms of the seriousness of cancer cell spread, cancers are classified into stage 0 (carcinoma in situ) and stages I-IV.…”