S1004 B-PREDICT Trial: How Often Do People Respond to the Yearly Invitation for Prevention of Colorectal Neoplasia With an Immunological FOBT (iFOBT)

Objective: The aim was to evaluate the patterns and predictors of resource use related to diagnosing colorectal cancer (CRC).Methods: Supplementary medical record data were systematically abstracted on VA (Veterans Affairs) patients with CRC enrolled in Cancer Cares Outcomes Research and Surveillance (CanCORS), a prospective cohort study of approximately 10,000 newly diagnosed colorectal and lung cancer patients.One of the seven CanCORS research teams is a consortium of 15 geographically diverse VA centers.For this study, the VA medical records were examined up to 24 months prior to confirmed tissue diagnosis and merged with data from the main CanCORS study.Clinical services related to the diagnosis of CRC were grouped as laboratory tests, imaging studies, and subspecialty consultations.Cumulative logit regression models were used to determine the impact of potential predictors including sociodemographic data, cancer presentation (screen detected, symptom detected, incidentally detected) and comorbidities on the use of clinical diagnostic services.An OR >1 indicated a greater likelihood that more services (laboratory tests, imaging, subspecialty consultations) were used.Results: The sample of 447 subjects was 98% male, 66% Caucasian with a mean age of 67 years.The median number of services (interquartile range) were 2 (1-3) for laboratory tests, 1 (0-2) for subspecialty consultations, and 1 (0-2) for imaging.Use of subspecialty consultations was significantly associated with facility geographic location with less utilization in the West Midwest region and South region compared to the Atlantic region odds ratios (OR) 0.43(95% CI 0.27-0.68))and 0.53(95% CI 0.34-0.83)respectively.Lower utilization of imaging was found in the West-Midwest compared to the Atlantic region OR 0.46(95% CI 0.30-0.72).Older patients had higher use of consultations (OR 1.30 (95% CI 1.10-1.54))and laboratory tests (OR 1.20 (95% CI 1.02-1.40))compared to younger patients.Incidentally discovered CRC had more use of all diagnostic clinical services compared to screen detected CRC with OR for consultations, imaging studies, and laboratory tests of 1.80 (95% CI 1.18-2.74),1.59 (95% CI 1.06-2.38)and 3.10( 95% CI 2.07-4.62) .There was no association between diagnostic resources use and cancer stage, race, comorbidity index, or marital status.Conclusion: Variability in utilization of diagnostic clinical services exists and was associated with patient age, cancer presentation, and facility location.Further investigation to understand the reasons behind the variability may identify more efficient diagnostic strategies and reduce unnecessary testing.