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. 2021 Mar;28(1):18-24.
doi: 10.1177/0969141320903756. Epub 2020 Feb 13.

Cross-sectional adherence with the multi-target stool DNA test for colorectal cancer screening: Real-world data from a large cohort of older adults

Emily Weiser  1 , Philip D Parks  1 , Rebecca K Swartz  1 , Jack Van Thomme  1 , Philip T Lavin  2 , Paul Limburg  3 , Barry M Berger  1
Affiliations

Cross-sectional adherence with the multi-target stool DNA test for colorectal cancer screening: Real-world data from a large cohort of older adults

Emily Weiser et al. J Med Screen. 2021 Mar.

Abstract

Objective: To determine cross-sectional adherence with the multi-target stool DNA test used for colorectal cancer screening in a large, fully insured Medicare population.

Methods: All patients aged 65-85 with a valid multi-target stool DNA test order from 1 September 2016 to 31 August 2017 identified from the Exact Sciences Laboratories (Madison, WI; sole-source national multi-target stool DNA test provider) database were evaluated for test adherence. Cross-sectional adherence, defined as multi-target stool DNA test completion within 365 days from order date, was analyzed overall and by time to adherence, as well as by available patient (age, sex, test order date, Medicare coverage type) and provider (specialty, year of first multi-target stool DNA test order, multi-target stool DNA test order frequency, and practice location) factors.

Results: Among 368,494 Medicare beneficiaries (64% female), overall cross-sectional adherence was 71%. Cumulative adherence rates increased more rapidly at 30 (44%) and 60 (65%) days, followed by more gradual increases at 90 (67%), 180 (70%), and 365 (71%) days. By provider specialty, primary care clinicians represented a higher percentage of multi-target stool DNA orders than gastroenterologists (88% vs. 6%), but had a lower associated patient adherence rate (71% vs. 78%).

Conclusions: In this large, national sample of Medicare insured older adults, nearly three-quarters of patients adhered with a multi-target stool DNA order for colorectal cancer screening. These real-world data should inform further clinical and population health applications, reimbursement model simulations, and guideline-endorsed colorectal cancer screening strategies adherence.

Keywords: Colorectal neoplasia prevention; Medicare cohort studies; cologuard; colorectal cancer screening; patient navigation.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: This study represents a collaboration between investigators at Mayo Clinic and Exact Sciences Corporation (Madison, Wisconsin). Dr. Limburg serves as Chief Medical Officer for Screening at Exact Sciences through a contracted services agreement with Mayo Clinic. Dr. Limburg and Mayo Clinic have contractual rights to receive royalties through this agreement. Berger is a clinical consultant to and equity holder of Exact Sciences. Weiser, Parks, Swartz, and Van Thomme are employees of Exact Sciences.

Figures

Figure 1.
Figure 1.
Approximate timing of patient navigation activities following the receipt of an order for the multi-target stool DNA test for colorectal cancer screening at the laboratory. Note: Patient contact and response are variable and generally occur within the day range provided. Mt-sDNA: multi-target stool DNA. aThe live support line is available 24 h per day, 7 days per week, 365 days per year and includes a provider support function for healthcare staff. Navigation staff fluent in more common languages are complemented by third-party telephonic, real-time translation support.
See this image and copyright information in PMC

References

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