Abstract A140: Stool-Based Colorectal Cancer Screening During the COVID-19 Pandemic in a Safety-Net Setting: A Mixed-Methods Study
Authors: Pastard Willow , Kaplan Cameron , Lam Chun Nok , Solano Laura , Saluja Sonali , Axeen Sarah , Thacker John , Schneberk Todd , Tsui Jennifer 
Published: September 2024

Abstract
Purpose: The COVID-19 pandemic resulted in a marked decrease in preventative screening services for colorectal cancer, especially for more involved procedures like colonoscopies. Nationally, some health systems turned to more socially distanced options such as fecal immunochemical tests (FIT) and guaiac fecal occult blood tests (gFOBT). This study aimed to examine the effects of pandemic protocols on FIT and gFOBT utilization in a large municipal safety-net setting. Methods: This mixed methods study examined primary care visits in Los Angeles County’s municipal safety-net system. Semi-structured interviews were conducted with key stakeholders at multiple levels of the organization. These insights were combined with analysis of structured Electronic Health Record data on orders and procedure codes for completed colorectal cancer screening, including screening colonoscopies and FIT/gFOBT tests within the Los Angeles County health system’s ambulatory care and hospital-based providers, in order to explore trends in colorectal cancer screening during the pandemic. Results: Pre-pandemic, stool tests such as FIT and gFOBT were already the dominant initial screening modality for colorectal cancer in the health system. Across the system, FIT/gFOBT rates decreased during the initial wave of the pandemic and took significant time to recover to pre- pandemic levels. System stakeholders noted significant challenges with utilization of stool sample modalities as a screening method during the pandemic, including poor return rates and patient hesitancy to come in person to receive or return tests. Efforts were made to improve upon utilization, for example implementing distribution of stool tests like the FIT via mail. Rates of screenings may also have been affected by the increase in use telehealth services during the pandemic, by which providers often communicated with patients to order FIT/gFOBT tests during the period. Conclusion: Socially distanced approaches to colorectal cancer screening were an attractive solution for safety-net health systems looking to continue preventative care efforts in a pandemic setting. Our study highlights unique challenges exacerbated by the pandemic that should be considered in the context of future utilization of these screening modalities. In the post-pandemic term, emphasis on FIT/gFOBT utilization, in combination with lessons learned during the pandemic, could help to overcome delays in screening precipitated by COVID-19 by decreasing barriers to access for vulnerable populations (e.g. transportation access, work flexibility) in comparison to endoscopy.
Citation Format: Willow Pastard, Cameron Kaplan, Chun Nok Lam, Laura Solano, Sonali Saluja, Sarah Axeen, John Thacker, Todd Schneberk, Jennifer Tsui. Stool-Based Colorectal Cancer Screening During the COVID-19 Pandemic in a Safety-Net Setting: A Mixed-Methods Study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A140.