The influence of multi-morbidities on colorectal cancer screening recommendations and completion

Abstract

Purpose: Patients' chronic disease burden can influence the likelihood that providers will recommend cancer screening and that patients will participate in it. Using data from the STOP CRC pragmatic study, we examined associations between chronic disease burden and colorectal cancer screening recommendation and use.

Methods: Participating STOP CRC clinics (n = 26) received either usual care or training to implement a mailed fecal immunochemical test (FIT) outreach program. Selected clinic patients (n = 60,187 patients) were aged 50-74 and overdue for colorectal cancer screening. We used logistic regression to examine the associations between FIT recommendations and completion and patients' chronic disease burden, calculated using the Charlson Comorbidity Index and the Chronic Illness and Disability Payment System.

Results: For each index, FIT recommendation odds were 8-9% higher among individuals with minimal chronic disease burden and 13-23% lower among individuals with high chronic disease burden (inverted U-shaped association). Among adults who were ordered a FIT, FIT completion odds were 20% lower for individuals with any, versus no, chronic condition and diminished with increasing disease burden (inverse linear association).

Conclusions: Analysis showed an inverted U-shaped association between patients' chronic disease burden and providers' recommendation of a FIT and an inverse linear association between patients' chronic disease burden and FIT completion. ClinicalTrials.gov registration: NCT01742065.

Keywords: Charlson comorbidity index; Chronic Illness and Disability Payment System; Colorectal cancer screening; Federally qualified health centers; Multiple chronic conditions.

Fig. 1

Probability of FIT order, FIT completion by morbidity score calculated using Charlson co-morbidity index and Chronic Illness and Disability Payment System index Compared to individuals with a Charlson Comorbidity Index (CCI) of 0, receipt of a FIT order was slightly higher for individuals with a CCI of 1 and displayed a downward trend for CCI scores of 2–5. Odds of FIT return decreased with increasing CCI score.

Fig. 2

Probability of FIT order, FIT completion by morbidity score calculated using the Chronic Illness and Disability Payment System index Compared to individuals with a Chronic Illness and Disability Payment System (CDPS) of 0, receipt of a FIT order was slightly higher for individuals with a CDPS of 1–4 and lower for individuals with a CDPS of 5. Odds of FIT return and completion of any CRC screening decreased with increasing CDPS score.