Adherence to repeat screening for colorectal cancer using the multi-target stool DNA test: Real-world analysis of patients from federally qualified health centers.

Abstract

3630 Background: Initial and repeat colorectal cancer (CRC) screening rates are suboptimal and fall short of national goals in adults from historically disadvantaged backgrounds. This real-world study examined adherence to repeat mt-sDNA screening among patients from federally qualified health centers (FQHCs) across the US and among different payer types. Methods: Laboratory data from Exact Sciences Laboratories LLC were utilized for the period between January 1, 2023, and December 31, 2023, for those who had previously completed a mt-sDNA test. Study outcomes included adherence rate to mt-sDNA repeat screening and time to test return. The mt-sDNA screening adherence rate was defined as the percentage of patients who completed and returned the test kit and received a valid test result within 180 days of the initial shipment date. Time to test return was defined as the number of days from the date the test kit was shipped to the patient to the date ESL received the test kit with a specimen. Results: The study sample consisted of 19,536 eligible patients, including 9,592 (49.1%) aged 45-64 years, 8,689 (44.5%) aged 65-75 years and 1,225 (6.4%) aged 76-85 years. Overall, the mt-sDNA repeat screening adherence rate was 79.7% and the mean time to return the kit was 21.1±20.8 days. A total of 2,375 (15.3%) individuals tested positive for CRC. Screening adherence for patients with Medicare was 84.7%, Medicare Advantage was 80%, commercial insurance was 78.2%, managed care organization was 74.6% and Medicaid was 65.9% (p < 0.001). Compared with patients covered by commercial insurance, those covered by Medicaid had 42% lower odds of adhering to mt-sDNA screening (OR: 0.582, 95% CI]: 0.461-0.733, p < 0.001). Patients with 2 or more prior successful tests had a numerically shorter mean time to test return compared to those with only 1 prior successful test, both overall and within each payer type. Conclusions: Findings from this real-world study suggest that patients receiving care from FQHCs had relatively high repeat mt-sDNA screening rates. While repeat screening adherence was generally high across patient demographic categories, there were significant differences by type of insurance coverage and number of prior successful mt-sDNA screenings.