Colorectal Cancer Screening Patient Navigation for Patients with Mental Illness and/or Substance Use Disorder: Pilot Randomized Control Trial

Abstract

Objective

Colorectal cancer (CRC) is the second leading cause of cancer death in the US. Screening has decreased CRC mortality. However, disadvantaged patients, particularly those with mental illness or substance use disorder (SUD), are less likely to be screened. The aim of this trial was to evaluate the impact of a patient navigation program on CRC screening in patients with mental illness and/or SUD.

Methods

A pilot randomized nonblinded controlled trial was conducted from January to June 2017 in an urban community health center serving a low-income population. We randomized 251 patients aged 50–74 years with mental illness and/or SUD diagnosis overdue for CRC screening to intervention (n = 126) or usual care (n = 125) stratified by mental illness, SUD, or dual diagnosis. Intervention group patients received a letter followed by a phone call from patient navigators. Navigators helped patients overcome their individual barriers to CRC screening including: education, scheduling, explanation of bowel preparation, lack of transportation or accompaniment to appointments. If patient refused colonoscopy, navigators offered fecal occult blood testing. The main measure was proportion of patients completing CRC screening in intervention and usual care groups.

Results

Navigators contacted 85 patients (67%) in the intervention group and 26 declined to participate. In intention-to treat analysis, more patients in the intervention group received CRC screening than in the usual care group, 19% versus 10.4% (p = .04). Among 56 intervention patients who received navigation, 19 completed screening (33.9% versus 10.4% in the control group, p = .001). In the subgroup of patients with SUD, 20% in the intervention group were screened compared to none in the usual care group (p = .05).

Conclusions

A patient navigation program improved CRC screening rates in patients with mental illness and/or SUD. Larger studies in diverse care settings are needed to demonstrate generalizability and explore which modality of CRC screening is most acceptable and which navigator activities are most effective for this vulnerable population.

Trials Registration Number

2016P001322

Keywords:

• Colorectal cancer screening
• patient navigation
• dual diagnosis

Acknowledgments

The authors thank the patient navigators and recovery coach at the MGH Charlestown Health Care Center.

Disclosure statement

Dr. Atlas has no conflicts of interest related to this topic. He is the UpToDate section editor for low back and neck pain related topics. He received support for a study on atrial fibrillation from Boeringer Inglehiem. He currently receives support for research on atrial fibrillation from the American Heart Association and Bristol Myers Squibb/Pfizer alliance. He also has a consultancy agreement for BMS/Pfizer. He also owns stock in Abbott Laboratories, Amgen and Stryker. Dr. Ashburner has received sponsored research support from BMS/Pfizer and Boeringer Inglehiem.

Dr. Percac-Lima has no conflicts of interest related to this manuscript. She receives support from NIH, PCORI, and Merck Foundation for her research. She received compensation as a consultant from Goodell Devries Law Firm. Dr. Abuelo has consulted for Biohaven Pharmaceuticals. The other authors have no conflicts of interest.

Additional information

Funding

Dr. Abuelo was partially funded by a fellowship from the Kraft Foundation.