colorectal cancer

Fecal immunochemical tests (FIT) are commonly used as a screening method for colorectal cancer. However, patient adherence is often insufficient to ensure full effectiveness of the program. A recent study investigated the impact of automated SMS and phone call reminders on patients’ adherence to FIT screening and their results show that both measures led to a substantial improvement.


A fecal immunochemical test (FIT) consists of examining a patient’s stool sample to detect blood, which may constitute an early sign of colorectal cancer. It offers several advantages over other methods including its simplicity and relatively rapid diagnosis. In fact, patients are only expected to provide a stool sample collected at home, which can then be examined in a proper laboratory setting.

However, to ensure full effectiveness of such screening programs, patients’ participation must be diligent over multiple years in part because false-negatives can arise from cancer lesions without any ensuing bleeding. This aspect severely impinges on the success rate of FIT screening programs, which still suffer from patient’s poor longitudinal adherence. New strategies need to be implemented to improve patient adherence.

In a recent randomized clinical trial recently published in JAMA Oncology, a Chinese group investigated the efficacy of SMS and phone call reminders on patient adherence to FIT screening programs. Patients were divided into three groups: 1) a control group in which patients were told to schedule a visit to the screening center within a year; 2) an “SMS” group in which patients received by SMS a friendly reminder of the date, time and importance of their visit one month in advance and 3) a “phone call” group in which patients received a phone call from a physician. Overall, the analysis was performed on 207 patients in the control group, 209 in the SMS group and 205 in the phone call group.

Their results show a convincing positive impact of both SMS and phone call reminders on patients’ adherence to the program. In fact, while only 69.1% of the patients participated after one year, this proportion increased to 82.8% and 91.2% in the SMS and phone call groups, respectively (P < 0.001). Furthermore, these data also suggest that making verbal contact with a physician further increases the efficacy of the reminder. However, it remains unclear whether this latter observation can be explained by the “semi-authoritarian” relationship between the physician and his patient or by a verbal contact with any human being. While these results await confirmation from other studies, they certainly stress the importance of implementing novel strategies to improve adherence to FIT screening programs.


Written By: Samuel Rochette, M.Sc

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