Is Promotion of Fecal Immunochemical Testing "FIT" to Address COVID-19 Disruptions to Colorectal Cancer Screening?
Is Promotion of Fecal Immunochemical Testing "FIT" to Address COVID-19 Disruptions to Colorectal Cancer Screening?
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DOI：
10.1053/j.gastro.2021.11.030
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发表时间：
2022-05
期刊：
影响因子：
29.4
通讯作者：
Gupta S
中科院分区：
文献类型：
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作者：
Trivedi M;Gupta S
2019冠状病毒病（COVID-19）大流行扰乱了结直肠癌（CRC）筛查的参与。需要采取战略减轻COVID对结直肠癌结局的影响。Issaka等人使用模拟模型研究了积极促进粪便免疫化学检测（FIT）对筛查摄取和结果的潜在影响。之所以选择FIT推广策略，是因为在随机试验中，邮寄FIT外展一直显示可以增加筛查的接受度；一些卫生系统已经成功地使用邮寄FIT外展来增加筛查参与，表明这一战略是可行和有效的。该模型考虑了在3年时间范围内参与筛查的4种情况的影响，以筛查的人数和检测到的crc作为主要结果。这些情景在与covid - 19相关的筛查中断的持续时间和积极促进FIT以减轻中断的程度上有所不同，并与基线情景进行了比较，在基线情景中，大流行前的筛查参与率保持在较高水平，就好像大流行没有发生一样。模拟的备选情景为：(1)3年内筛查参与的早期或部分恢复到大流行前水平的62%（情景1）；(2)筛查在3年内部分恢复到大流行前水平的57%所需时间延长（情景2）；(3)通过模拟提高FIT推广和参与程度，在3年内尽早部分恢复到大流行前水平的75%（情景3）；(4)通过模拟增加的FIT，在3年内将筛查部分恢复到大流行前水平的71%所需的时间延长（情景4）。FIT参与增加的估计是基于一个完善的常规护理FIT外展计划的结果。
The coronavirus disease 2019 (COVID-19) pandemic has disrupted colorectal cancer (CRC) screening participation. Strategies to mitigate the impact of COVID on CRC outcomes are needed. Issaka et al used a simulation model to study potential impact of active promotion of fecal immunochemical testing (FIT) on screening uptake and outcomes. A FIT promotion strategy was selected because mailed FIT outreach has been shown consistently to increase screening uptake in randomized trials; some health systems have successfully used mailed FIT outreach to increase screening participation, indicating that this strategy is feasible and effective.The model considered the impact of 4 scenarios of screening participation over a 3-year time horizon, with the number of people screened and CRCs detected as the primary outcomes. The scenarios varied the duration of COVID-related screening disruptions and the extent to which FIT was actively promoted to mitigate disruptions, and were compared to a baseline scenario in which high prepandemic screening participation rates were sustained as if the pandemic had not occurred. Alternate scenarios modelled were (1) early time to partial recovery of screening participation to 62% of prepandemic levels over 3 years (scenario 1);(2) a prolonged time to partial recovery of screening to 57% of prepandemic levels over 3 years (scenario 2);(3) early time to partial recovery to 75% of prepandemic levels over 3 years by modeling increased FIT promotion and participation (scenario 3); and (4) a prolonged time to partial recovery of screening to 71% of prepandemic levels over 3 years by modeling increased FIT (scenario 4). The estimate of increased FIT participation was based on results from a well-established usual care FIT outreach program.