Comparative effectiveness of FIT vs. colonoscopy for colon cancer screening

FIT 与结肠镜检查对结肠癌筛查的有效性比较

• 批准号: 7944020
• 负责人: BARCEY Thurston LEVY
• 金额: $ 37.75万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-29 至 2011-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7944020
• 关键词: Address; Adopted; Advisory Committees; Age; Area; Attitude; Cancer Etiology; Cessation of life; Characteristics; Clinical; Colon; Colon Carcinoma; Colonoscopy; Colorectal Cancer; Communities; Complication; Country; Data; Decision Analysis; Decision Making; Disadvantaged; Disease; Family Physicians; Foundations; Funding; Future; Goals; Gold; Healthcare Systems; Human Resources; Incidence; Individual; Insurance; Iowa; Life; Methods; Modality; Patient Preferences; Patients; Physicians; Population; Preparation; Preventive; Primary Health Care; Procedures; Publishing; Qualifying; Recommendation; Research; Research Infrastructure; Research Personnel; Risk; Rural; Sampling; Sampling Studies; Screening for cancer; Screening procedure; Self-Administered; Services; Site; Staging; Surveys; Testing; Thinking; Time; Training; Underinsured; United States; Woman; base; clinical practice; colorectal cancer screening; comparative effectiveness; cost; effectiveness research; follow-up; high risk; improved; men; men' s group; older women; population based; practice-based research network; preference; programs

DESCRIPTION (provided by applicant): This application addresses Broad Challenge Area (5), Comparative Effectiveness Research, and specifically Comparative Effectiveness Research on Cancer Screening, 05-CA-102. Significance: With our health care system in financial crisis, and colorectal cancer (CRC) both the second leading cause of cancer death and a largely preventable disease, there is a critical need for high quality comparative effectiveness studies of CRC screening modalities. The recent United States Preventive Services Task Force (USPTF) decision analysis found no difference in life-years gained by CRC screening using colonoscopy every 10 years vs. annual fecal immunochemical testing in individuals aged 50 to 75.1 However, although studies comparing FIT and colonoscopy have been conducted in non-screening populations2, 3 and populations outside the United States4-6, no studies using average-risk patients have been conducted in the United States directly comparing these methods. We will compare the test characteristics of a fecal immunochemical test (FIT) with colonoscopy in 700 average risk individuals undergoing screening colonoscopy; assess patient preferences for FIT vs. colonoscopy in the study sample; and compare projected costs using these screening strategies. This study will help lay the foundation for a multi-site primary care practice- based trial for two-step CRC screening (FIT followed by colonoscopy for those who test positive on FIT) using our Iowa Research Network (IRENE). IRENE is a primary care, practice-based research network of over 300 family physicians in 200 practices. The results of this pilot and the future larger scale study would allow specific clinical recommendations to be developed and recommended based on actual normal risk US data rather than on high risk, non-screening US populations and/or non-US data alone, as has been the case until now. This study will provide critical information on the test characteristics of a fecal immunochemical test for colon cancer screening in an average risk U.S. population and individual's attitudes and preferences for these tests, which will help lay the foundation for a larger colorectal cancer screening trial to be conducted in our primary care practice-based rural research network, the Iowa Research Network. The larger, future trial will involve fecal immunochemical testing, followed by colonoscopy for those who are FIT positive, in a sample of average-risk individuals across the state of Iowa.

描述（由申请人提供）：本申请涉及广泛的挑战领域 (5)、比较有效性研究，特别是癌症筛查的比较有效性研究，05-CA-102。意义：由于我们的医疗保健系统陷入金融危机，结直肠癌 (CRC) 既是癌症死亡的第二大原因，又是一种基本上可以预防的疾病，因此迫切需要对结直肠癌筛查方式进行高质量的比较有效性研究。最近的美国预防服务工作组 (USPTF) 决策分析发现，对于 50 至 75 岁的个体，每 10 年使用结肠镜检查进行 CRC 筛查与每年进行粪便免疫化学检测相比，获得的生命年没有差异。1 然而，尽管已在非筛查人群 2、3 和美国以外的人群 4-6 中进行了比较 FIT 和结肠镜检查的研究，但美国尚未开展使用平均风险患者的研究直接比较这些人群 方法。我们将对 700 名接受筛查性结肠镜检查的平均风险个体进行粪便免疫化学测试 (FIT) 与结肠镜检查的测试特征进行比较；评估研究样本中患者对 FIT 与结肠镜检查的偏好；并比较使用这些筛选策略的预计成本。这项研究将有助于利用我们的爱荷华州研究网络 (IRENE) 进行基于多地点初级保健实践的两步 CRC 筛查试验（FIT，然后对 FIT 检测呈阳性的人进行结肠镜检查）奠定基础。 IRENE 是一个基于实践的初级保健研究网络，由 200 个诊所的 300 多名家庭医生组成。该试点和未来更大规模研究的结果将允许根据实际的正常风险美国数据制定和推荐具体的临床建议，而不是像迄今为止的情况那样仅根据高风险、非筛查美国人群和/或非美国数据。这项研究将提供关于美国平均风险人群结肠癌筛查粪便免疫化学测试的测试特征以及个人对这些测试的态度和偏好的关键信息，这将有助于为我们基于初级保健实践的农村研究网络爱荷华州研究网络进行更大规模的结直肠癌筛查试验奠定基础。未来更大规模的试验将涉及粪便免疫化学检测，然后对爱荷华州平均风险个体样本中的 FIT 阳性患者进行结肠镜检查。