The COVID-19 pandemic created new barriers for colorectal cancer screening. However, fecal occult blood tests done at home may boost colonoscopy compliance, according to a presentation at the American College of Surgeons Clinical Congress.
“The key message from our findings is that barriers to screening have increased during the pandemic, and we have to find a way to work with the community to increase those rates,” Kristine Kenning, MD, MS, chief general surgery resident at Virginia Commonwealth University School of Medicine in Richmond, Virginia, said in an American College of Surgeons press release. “Our study found that people are compliant with, and willing to do, home-based fecal occult blood testing. This test provides a very important way for us to increase screening for colorectal cancer.”
Kenning and colleagues performed a cross-sectional survey assessing attitudes toward CRC screening during the pandemic in 745 patients eligible for screening.
Results showed patients who responded had higher fecal occult blood test (FOBT) completion within the past 3 years compared with the American Cancer Society’s reported pre-COVID use of FOBT (32% vs. 11%; P < .0001), with 42% of survey respondents completing the FOBT during the pandemic. Investigators noted there were similar colonoscopy completion rates (65% vs. 61%).
According to researchers, compared with pre-COVID-19 rates, patients who responded had higher unemployment rates (7.4% vs. 2.6%; P < .0001).
“Given higher unemployment and COVID infection risk, respondents confirmed concerns about copays and COVID when scheduling colonoscopies (52.4% and 65.9% respectively),” the authors wrote in the abstract. “Of those who had concerns, some reported this delayed their screening (57.6% and 59.9% respectively).”
Those who were unemployed with household income less than $25,000 and without healthcare insurance were more likely to have copay concerns. Patients who were women, never married or widowed and in poor health were more likely to have COVID concerns.
Researchers also asked patients what changes would increase screenings during the pandemic. The chance for colonoscopy increased 30.7% with offering of gloves and masks, 30.7% with smaller offices and 19.7% with weekend screenings. Of the 51% of patients willing to do at-home FOBT instead of a colonoscopy, 93% reported they would be willing to do a follow-up colonoscopy if the FOBT was positive.
“Even pre-pandemic, the rates for colorectal screening in the United States were very far
from 100%, so I think the lessons that we are learning from this pandemic and
working with patients to find alternatives to what the conventional approaches have been in the past are going to be applicable to care moving forward,” study senior author Emily Burke Rivet, MD, MBA, FACS, FASCRS, colon and rectal surgeon at Virginia Commonwealth University School of Medicine, said in the press release. “This approach applies even if we do eventually enter a post-pandemic state, which is, of course, what we are all hoping for.”
