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SAN DIEGO -- An emphasis on fecal immunochemical testing (FIT) as a screening strategy for colorectal cancer allowed a Veterans Administration (VA) hospital to return to pre-COVID-19 pandemic screening levels and enabled staff to address a screening backlog dating to the start of the pandemic in early 2020, according to research presented here.

Via a quality improvement initiative, the Edward J. Hines Jr. VA Hospital in Hines, Illinois, was able to boost the total number of FIT kits processed at the hospital from 2,058 in 2019 to 3,456 in 2021 (a 68% increase), while reducing the number of screening colonoscopies by 52%, reported Michelle Popadiuk, MBA, LPN, during a poster presentation at the Association of VA Hematology/Oncology annual meeting.

The hospital also met its secondary goal of increasing the number of monthly screenings by enough to start addressing its colorectal cancer screening backlog.

"This supports the fact that FIT kits were a good option for screening average-risk patients while in-person screening was restricted," Popadiuk said, adding that "the FIT kit was a critical screening option to use during the height of the pandemic, and has remained an important option."

As with many other routine medical procedures, the pandemic significantly curtailed cancer screening at Hines VA. As a result, the hospital performed 50% fewer colorectal cancer screenings in 2020 versus 2019, according to Popadiuk.

Thus, Hines VA, along with nearly 750 other accredited cancer programs, chose to participate in a national quality improvement initiative called the , which was led by the American College of Surgeons in collaboration with the American Cancer Society.

The program sites were instructed to participate in one or multiple independent quality improvement projects for breast, colon, lung, and cervical cancer screening, with the goal of identifying and closing cancer screening deficits. For each of these projects, facilities calculated a monthly screening test volume (an absolute count measure of the number of screening tests performed per month), and compared pre-pandemic and pandemic results.

Working from a list of recommended screening tests for each disease site, each facility specified which screening test or tests they should measure.

At Hines VA, the quality improvement initiative was formulated by a multidisciplinary leadership team, "which was able to identify simple, but really important, interventions that would help with our processes, particularly for average-risk patients," Popadiuk said.

Hines VA initiated their program aimed at increasing the use of FIT as an alternative screening method for average-risk patients while colonoscopies were restricted, with the primary goal of returning to pre-pandemic rates of screening (for both colonoscopy and FIT combined).

A secondary goal was to increase monthly screenings by at least 10% in order to address the screening backlog.

Along with standardizing processes identifying average-risk patients who are due or overdue for screening, and disseminating and processing FIT kits, it was critical to be able to educate patients on how to use the kits, Popadiuk said.

"We understood the instructions within the FIT kits were completely complex," she noted. "But there are evidence-based interventions where you can provide simple, plain language scripted instructions to patients, so that they can understand and quickly learn to use the kits."

The center's nursing staff was instrumental in patient follow-up, Popadiuk added. "We can hand out the FIT kits, and educate our patients, but follow-up was critical and the nursing team really helped us understand how we were doing with the intervention."

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