A survey of primary care patients who were offered but did not undergo colon cancer screening found that more than four-fifths would be willing to undergo virtual colonoscopy (also known as CT colonography or CTC) -- but not if they had to pay the entire cost out of pocket.
Results of the small, single-center survey suggest that insurance coverage for virtual colonoscopy could make a big difference in increasing colon cancer screening compliance, now hovering at around 50% of the eligible U.S. population older than 50.
In March 2008, the Joint Guideline from the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology added CTC to the list of recommended options for colorectal cancer screening.
A number of studies have suggested that patients may be more willing to undergo CTC than conventional colonoscopy, because CTC is less invasive and does not require sedation, among other reasons.
However, because virtual colonoscopy isn't covered under Medicare (the U.S. Centers for Medicare and Medicaid Services declined to offer national coverage in a controversial 2009 decision), most third-party healthcare payors are unwilling to pay for any part of the exam, leaving most patients who want VC to pick up the entire cost out of pocket.
The study findings "indicate that adherence to colorectal cancer screening could be increased along with the widespread availability of CTC as a colorectal cancer screening technique," wrote Wendy Ho, MD, and colleagues from Massachusetts General Hospital in Boston (American Journal of Roentgenology, August 2010, Vol. 195:2, pp. 393-397).
Ho and her team invited 175 asymptomatic adults to participate; all had been offered colorectal cancer screening but had declined. The researchers were left with 68 subjects older than 50 (59% male, 88% white, 96% between ages 50 and 64 years) to be included in the analysis. The authors cited the small survey total as the main limitation of the study, limiting its predictive power. They were confident that they had approached the right group of patients, however.
"Our study specifically targeted patients who were known to have been offered colorectal cancer screening and were not adherent to these recommendations," Ho and her team wrote. "We think that studying this specific group of subjects provides the best information regarding how CTC availability might affect colorectal cancer screening rates."
Most previous surveys addressing CTC or colonoscopy have been given to patients who underwent screening or were younger than 50, the group noted.
The survey elicited information such as history of colorectal cancer, demographic characteristics, and adherence to other cancer screening recommendations. The subjects were asked questions that explored their reasons for not undergoing screening with any available method, including conventional colonoscopy and the fecal occult blood test (FOBT).
Next, they were asked to read a brochure describing virtual colonoscopy and indicate their willingness to undergo CTC. Their responses indicated that 46% were "Very Willing," 37% were "Somewhat Willing," and 16% were "Not Willing." Combining the two positive responses, a total of 83% were willing to undergo CTC.
"However, 70% stated that they would not be willing to pay out-of-pocket fees if insurance did not cover CTC, and even among the 30% who were willing to pay the fees, the average amount they were willing to pay" (mean, $244; median, $150; range, $50-$1,000) was well below current rates for CTC, Ho and colleagues wrote.
The researchers were unable to identify significantly predictive patient characteristics associated with a willingness to undergo CTC.
"Notably, most (65%) of the patients who were not adherent to colorectal cancer screening recommendations reported having had breast and prostate cancer screening in the past," the authors wrote. "Our finding is consistent with previous analyses suggesting that there are significant barriers that may be specific to colorectal cancerscreening (e.g., bowel cleansing preparation)."
The most common stated reason for a lack of screening to date was procrastination (38%); another 12% of subjects said they were too busy. Bowel cleansing was a barrier to screening for 24% of subjects, and 15% said they felt colorectal cancer screening was too embarrassing; 13% thought it was too invasive. Sixteen percent said they were afraid of learning the test results, and another 19% were discouraged by negative reports on screening by friends and family.
Also of note, only 4% of respondents had a family history of colorectal cancer, a finding that could indicate individuals with a negative family history of the disease may be less likely to be screened.
After being informed about CTC, most nonadherent patients said they would be willing to undergo CTC screening, but few would be willing to pay the full cost of it, the researchers concluded.
"Unless third-party reimbursement is expanded and becomes widespread (e.g., by Centers for Medicare and Medicaid Services), the cost to patients will likely be a significant barrier to widespread CTC implementation," they wrote.
By Eric Barnes
Auntminnie.com staff writer
August 9, 2010
Related Reading
Access to VC promoted as tool to increase screening, July 9, 2010
How 2009 went right and wrong: VC's own worst enemies, October 28, 2009
JACR editorial: Medicare used double standard in VC decision, September 22, 2009
NEJM editorial lauds CMS rejection of VC, May 28, 2009
CMS rejects Medicare coverage for virtual colonoscopy, May 12, 2009
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