Telephone-Based Intervention Improves Colorectal Cancer Screening in At-Risk Relatives of Patients With Colorectal Cancer
Individuals at increased familial risk of colorectal cancer have poor adherence to colonoscopy screening recommendations, especially those in rural and other geographically underserved populations. In a study (Family CARE trial) reported in the Journal of Clinical Oncology, Kinney et al found that a telephone-based strategy was effective in improving the colonoscopy screening rate in at-risk relatives of patients with colorectal cancer.
Study Details
In the study, 481 individuals aged 30 to 74 years who had not had risk-appropriate screening and were not candidates for genetic testing were recruited via contacting patients with colorectal cancer or their next of kin in five states (California, Colorado, Idaho, New Mexico, and Utah). Participants were randomly assigned as family units to receive active personalized intervention incorporating evidence-based risk communication and behavior change techniques (TeleCARE group, n = 232) or a mailed educational brochure (control group, n = 249).
All participants received a survey of self-reported baseline clinical information, including colonoscopy screening, family history of cancer, sociodemographics, and psychosocial data and a mailed educational brochure targeted to participant risk status; in addition, the TeleCARE group received mailed tailored visual aids, a tailored telephone cancer risk assessment and counseling session, mailed tailored summary letter of their telephone session, and a mailed tailored reminder card.
The TeleCARE intervention incorporated risk communication and behavior change approaches designed to improve perceptions about the threat of familial colorectal cancer, arouse fear, increase belief in colonoscopy benefits, and increase self-efficacy and motivation to undergo the procedure. Participants were informed that colonoscopy was the recommended screening strategy due to their risk status. Participants completed an outcome assessment at 9 months after the intervention. The primary outcome measure was verified colonoscopy within 9 months of the intervention.
The TeleCARE and control groups were generally balanced for age (mean, 50 and 51 years), race/ethnicity (white in 92% and 96%), marital status (74% and 77% married, 22% and 19% separated, widowed, or divorced), educational level (43% post–high school in both, 22% and 27% Bachelor’s degree), residence (75% and 80% urban, 25% and 20% rural), household income (20% and 17% < $30,000, 18% and 20% $30,000–$49,999, 16% and 14% % 50,000–$69,999, 35% and 40% ≥ $70,000), employment status (72% and 69% employed), health insurance (private for 71% and 70%, no coverage for 16% and 20%), and proportion with a personal health-care provider (66% and 65%). Fewer TeleCARE group participants were female (39% and 46%).
Improved Colonoscopy Rate
Of all 481 at-risk relatives, 79.8% completed the outcome assessments within 9 months, with no significant difference between groups in retention rate. Overall, 35.4% of those in the TeleCARE group vs 15.7% of those in the control group underwent colonoscopy within 9 months (odds ratio [OR] = 2.83, P < .001). Odds ratios were similar and significant in subgroup analyses for rural residence (2.89, 95% confidence interval [CI] = 1.53–5.46), urban residence (2.87, 95% CI = 1.85–4.46), household income < $30,000 (2.75, 95% CI = 1.37–5.55), and household income ≥ $30,000 (2.94, 95% CI = 1.19–4.53).
The investigators concluded, “Remote personalized interventions that consider family history and incorporate evidence-based risk communication and behavior change strategies may promote risk-appropriate screening in close relatives of patients with [colorectal cancer].”
Anita Y. Kinney, PhD, RN, of University of New Mexico Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by grants from the National Cancer Institute and Huntsman Cancer Foundation and others. Study author Randall W. Burt, MD, reported a consultant or advisory role with Myriad Genetics and honoraria from Myriad Genetics.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
