Barriers to Follow-Up Colonoscopy After Positive FIT or Multitarget Stool DNA Testing

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Figure 1.
Kaplan-Meier estimation of time-to-colonoscopy of patients who had FIT test and who had mt-sDNA. The median time-to-colonoscopy for patients FIT was N/A (50% rate was not reached for this group). The median (95% CI) time-to-colonoscopy for patients who had mt-sDNA was 2.16 (95% CI, 1.80-2.52) months. Abbreviation: FIT, fecal immunochemical testing.

Table 1.

Characteristics of FIT and mt-sDNA Tests

Characteristic	FIT	Mt-sDNA
Measures stool hemoglobin	Yes	Yes
Measures genomic markers	No	Yes
Approved as screening test	Yes	Yes
Labeling restricted to average risk patients	No	Yes
Recommended interval	1 year	3 years
Kit distribution	In-person or mail from local lab	Mail from external site
Kit return	In person or mail to local lab	Mail to external site
Reminder calls to return	No	Yes
Medicare out-of-pocket cost	$0	$0
Medicare reimbursement	$22	$483

Table 2.

Patient Characteristics of Cohort of 631 Patients

Variables	All Patients (n = 631), Mean (STD)/Frequency (%)	Mt-sDNA (n = 323)	FIT (n = 308)	P Value*
Age (years)	69.19 (10.57)	69.55 (7.95)	68.82 (12.76)	.39
Sex
Female	349 (55.3)	205 (63.47)	144 (46.75)	<.0001
Male	282 (44.7)	118 (41.84)	164 (53.25)
Hispanic
No	573 (99.13))	285 (99.30)	288 (98.97)	.66
Yes	5 (0.87)	2 (0.70)	3 (1.03)
Race
Asian	3 (0.49)	0 (0.00)	3 (0.99)
Black	48 (7.77)	17 (5.41)	31 (10.20)
Other	1 (0.16)	0 (0.00)	1 (0.33)	.064
White	563 (91.10)	296 (94.27)	267 (87.83)
Hispanic	2 (0.32)	1 (0.32)	1 (0.33)
Native	1 (0.16)	0 (0.00)	1 (0.33)
Insurance
Commercial	301 (47.7)	151 (46.7)	150 (48.7)
Medicaid	11 (1.7)	5 (1.6)	6 (1.9)
Medicare	290 (46)	158 (48.9)	132 (42.9)	.18
Self-pay	9 (1.4)	3 (0.9)	6 (1.9)
Unknown	20 (3.2)	6 (1.9)	14 (4.6)
Specialty
Family Medicine	368 (58.3)	143 (44.3)	225 (73)
Internal Medicine	242 (38.3)	163 (50.5)	79 (25.7)
GI	20 (3.2)	16 (4.9)	4 (1.3)	<.0001
Gynecology	1 (0.2)	1 (0.3)	0 (0)
Provider Gender
Female	317 (50.2)	175 (54.2)	142 (26.1)	.43
Male	314 (49.8)	148 (45.8)	166 (53.9)
Mid-Level Provider
Yes	37 (5.9)	22 (6.8)	15 (4.9)	.3
No (physician)	594 (94.1)	301 (93.2)	293 (95.1)

↵*P value was based on the comparison between two cohorts (FIT, mt-sDNA) of patients.
GI, gastroenterology; FIT, fecal immunochemical testin; STD, standard deviation.

Table 3.

Reasons for Lack of Follow-up after Positive mt-sDNA or FIT*

	FIT (n = 164) Frequency (%)	Mt-sDNA (n = 92) Frequency (%)
System
GI clinic referral	48 (29.3)	11 (12.0)
Colonoscopy not scheduled	5 (3.0)	17 (18.5)
Total	53 (32.3)	28 (30.4)
Provider level
Attributed to false positive	3 (1.8)	0 (0.0)
Failure to inform patient	0 (0.0)	7 (7.6)
Attributed to other reasons	39 (23.8)	1 (1.1)
Recent colonoscopy done	24 (14.6)	1 (1.1)
Other health issue to prioritize	8 (4.9)	11 (12.0)
Unknown	21 (12.8)	20 (21.7)
Total	95 (57.9)	40 (43.5)
Patient level
Patient refused (before ordered)	8 (4.9)	8 (8.7)
Patient refused (after ordered)	4 (2.5)	15 (16.3)
No show/cancellation	42 (25.6)	26 (28.3)
Did not complete bowel prep	0 (0)	1 (1.1)
Other reason	6 (3.7)	3 (3.3)
Total	60 (36.6)	53 (57.6)

Table 4.

Cox Regression Analysis on Time-to-Colonoscopy

Variables	Univariate Cox Regression			Multivariable Cox Regression
Variables	HR	95% CI of HR	P value	HR	95% CI of HR	P Value
Age (per year increase)	0.99	0.98, 1.00	.13	0.99	0.98, 1.00	.181
Sex (female vs male)	1.17	0.95, 1.43	.14	1.09	0.83, 1.32	.717
Race (Black vs White)	1.30	0.91, 1.85	.16	1.38	0.95, 2.00	.089
Insurance (commercial vs Medicare)	1.12	0.91, 1.38	.29	1.10	0.87, 1.39	.411
Screening test method (mt-sDNA vs FIT)	1.83	1.48, 2.25	< .0001	1.75	1.40, 2.19	< .0001
Specialty (FM vs IM)	0.87	0.71, 1.08	.202
Provider gender (female vs male)	1.30	1.06, 1.60	.01	1.19	0.95, 1.50	.125
Mid-level provider (yes vs no)	1.16	0.77, 1.75	.483