Baseline Features and Reasons for Nonparticipation in the Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) Study, a Colorectal Cancer Screening Trial

• Type of Material: Article
• Authors: Douglas J Robertson, White River Junction VA Medical Center; Jason A Dominitz, VA Puget Sound Health Care System; Alexander Beed, VA Connecticut Healthcare System; Kathy D Boardman, Clinical Research Pharmacy Coordinating Center, Albuquerque; Barbara J Del Curto, Clinical Research Pharmacy Coordinating Center, Albuquerque; Peter D Guarino, Fred Hutchinson Cancer Center, Seattle; Thomas F Imperiale, Indiana University; Andrew LaCasse, VA Puget Sound Health Care System, Seattle; Meaghan F Larson, VA Puget Sound Health Care System, Seattle; Samir Gupta, University of California, San Diego; David Lieberman, Portland VA Medical Center, and Oregon Health and Science University; Beata Planeta, VA Connecticut Healthcare System, West Haven; Aasma Shaukat, New York University Grossman; Shanaz Sultan, University of Minnesota; Stacy B Menees, VA Medical Center, Ann Arbor, Michigan; Sameer D Saini, University of Michigan; Philip Schoenfeld, 8John D. Dingell VA Medical Center, Atlanta; Stephan Goebel, Emory University; Erik C von Rosenvinge, University of Maryland; Gyorgy Baffy, Harvard Medical School; Ildiko Halasz, Harvard Medical School; Marcos C Pedrosa, Harvard Medical School; Lyn Sue Kahng, University of Illinois at Chicago; Riaz Cassim, Virginia University; Katarina B Greer, Case Western Reserve University; Margaret F Kinnard, Case Western Reserve University; Divya B Bhatt, University of Texas at Dallas; Kerry B Dunbar, University of Texas at Dallas; William V Harford, Jr, University of Texas at Dallas; John A Mengshol, University of Colorado; Jed E Olson, University of Colorado; Swati G Patel, University of Colorado; Fadi Antaki, Wayne State University; Deborah A Fisher, Durham VA Medical Center, Durham; Brian A Sullivan, Durham VA Medical Center, Durham; Christopher Lenza, New Jersey VA Healthcare System; Devang N Prajapati, University of California, San Francisco; Helen Wong, University of California, San Francisco; Rebecca Beyth, University of Florida; John G Lieb ll, University of Florida; Joseph Manlolo, VA Pacific Islands Health Care System, Honolulu; Fernando V Ona, University of Hawaii; Rhonda A Cole, Michael E. DeBakey VA Medical Center, Houston; Natalia Khalaf, DeBakey VA Medical Center, Houston; Charles J Kahi, Indiana University; Divyanshoo Rai Kohli, Kansas City VA Medical Center, Kansas City; Tarun Rai, Borland Groover Clinic, Jacksonville; Prateek Sharma, University of Kansas; Jiannis Anastasiou, University of Arkansas; Curt Hagedorn, University of New Mexico; Ronald S Fernando, University of California, Riverside; Christian S Jackson, University of California, Riverside; M. Mazen Jamal, University of California, Riverside; Robert H Lee, University of California, Irvine; Farrukh Merchant, V22 Clinical Resource Hub, Long Beach, California; Folasade P May, Greater Los Angeles VA Healthcare System, Los Angeles; Joseph R Pisegna, Greater Los Angeles VA Healthcare System, Los Angeles; Endashaw Omer, University of Louisville; Dipendra Parajuli, Robley Rex VA Medical Center, Louisville; Adnan Said, University of Wisconsin; Toan D Nguyen, University of Tennessee; Claudio Ruben Tombazzi, Memphis VA Medical Center; Paul A Feldman, University of Tennessee; Leslie Jacob, Bruce W. Carter VA Medical Center, Miami; Rachel N Koppelman, Bruce W. Carter VA Medical Center, Miami; Kyle P Lehenbauer, Minneapolis VA Healthcare System; Deepak S Desai, University of New York Stony Brook; Mohammad F Madhoun, University of Oklahoma, Oklahoma City; William M Tierney, Oklahoma City VA Medical Center; Minh Q Ho, University of Central Florida; Heather J Hockman, Malcolm Randall VA Medical Center, Gainesville; Christopher Lopez, Orlando VA Healthcare System; Emily Carter Paulson, University of Philadelphia; Martin Tobi, John D. Dingell VA Medical Center, Detroit; Hugo L Pinillos, University of Arizona; Michele Young, New Jersey VA Healthcare System, East Orange; Nancy C Ho, Science University, Portland; Ranjan Mascarenhas, The University of Texas at Austin; Kirrichai Promrat, VA Medical Center, Providence, Rhode Island; Pritesh R Mutha, University of Texas; William M Pandak, Jr, Virginia Commonwealth University; Tilak Shah, Cleveland Clinic Florida; Mitchell Schubert, Virginia Commonwealth University; Frank S Pancotto, Wake Forrest University; Andrew J Gawron, University of Utah; Amelia E Underwood, VA Medical Center; Samuel B Ho, Science University, Portland; Priscilla Magno-Pagatzaurtundua, VA Caribbean Healthcare System, San Juan; Doris H Toro, VA Caribbean Healthcare System, San Juan; Charles H Beymer, University of Washington; Andrew M Kaz, University of Washington; Jill Elwing, VA Medical Center, St Louis, Missouri; Jeffrey A Gill, University of South Florida; Susan F Goldsmith, James A. Haley VA Hospital, Tampa; Michael D Yao, Washington University; Petr Protiva, VA Connecticut Healthcare System, West Haven; Heiko Pohl, VA Medical Center, White River Junction, Vermont; Tassos Kyriakides, VA Connecticut Healthcare System, West Haven
• Language: English
• Date: 2023-07-03
• Publisher: JAMA Network Open.
• Publication Version: Final Published Version
• Copyright Statement: 2023 Robertson DJ et al. JAMA Network Open.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamanetworkopen.2023.21730
• Title of Journal or Parent Work: JAMA network open
• Volume: 6
• Issue: 7
• Start Page: e2321730
• End Page: e2321730
• Keywords: Neoplasms; Adult; Female; Early Detection of Cancer; Cross-Sectional Studies; Humans; Colonoscopy; Middle Aged; Male; Occult Blood
• Research Categories: Health Sciences, Oncology; Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Importance: The Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) randomized clinical trial sought to recruit 50 000 adults into a study comparing colorectal cancer (CRC) mortality outcomes after randomization to either an annual fecal immunochemical test (FIT) or colonoscopy. Objective: To (1) describe study participant characteristics and (2) examine who declined participation because of a preference for colonoscopy or stool testing (ie, fecal occult blood test [FOBT]/FIT) and assess that preference's association with geographic and temporal factors. Design, Setting, and Participants: This cross-sectional study within CONFIRM, which completed enrollment through 46 Department of Veterans Affairs medical centers between May 22, 2012, and December 1, 2017, with follow-up planned through 2028, comprised veterans aged 50 to 75 years with an average CRC risk and due for screening. Data were analyzed between March 7 and December 5, 2022. Exposure: Case report forms were used to capture enrolled participant data and reasons for declining participation among otherwise eligible individuals. Main Outcomes and Measures: Descriptive statistics were used to characterize the cohort overall and by intervention. Among individuals declining participation, logistic regression was used to compare preference for FOBT/FIT or colonoscopy by recruitment region and year. Results: A total of 50 126 participants were recruited (mean [SD] age, 59.1 [6.9] years; 46 618 [93.0%] male and 3508 [7.0%] female). The cohort was racially and ethnically diverse, with 748 (1.5%) identifying as Asian, 12 021 (24.0%) as Black, 415 (0.8%) as Native American or Alaska Native, 34 629 (69.1%) as White, and 1877 (3.7%) as other race, including multiracial; and 5734 (11.4%) as having Hispanic ethnicity. Of the 11 109 eligible individuals who declined participation (18.0%), 4824 (43.4%) declined due to a stated preference for a specific screening test, with FOBT/FIT being the most preferred method (2820 [58.5%]) vs colonoscopy (1958 [40.6%]; P < .001) or other screening tests (46 [1.0%] P < .001). Preference for FOBT/FIT was strongest in the West (963 of 1472 [65.4%]) and modest elsewhere, ranging from 199 of 371 (53.6%) in the Northeast to 884 of 1543 (57.3%) in the Midwest (P = .001). Adjusting for region, the preference for FOBT/FIT increased by 19% per recruitment year (odds ratio, 1.19; 95% CI, 1.14-1.25). Conclusions and Relevance: In this cross-sectional analysis of veterans choosing nonenrollment in the CONFIRM study, those who declined participation more often preferred FOBT or FIT over colonoscopy. This preference increased over time and was strongest in the western US and may provide insight into trends in CRC screening preferences.