F.I.T. Three little letters that can have a lasting impact on our health and well-being. When people think of ‘FIT’ – they usually think of things like New Year’s resolutions, lifestyle changes and exercise. But in the world of colon cancer screening – it has an entirely different meaning.
In the world of colon screening – FIT is our way of making a big difference!
Colorectal cancer is a disease that has impacted many in our province; in fact, Newfoundland and Labrador has among the highest rates of this form of cancer in the country. Screening is one of the best means of preventing colorectal cancer or detecting it in its earliest stages when it is most treatable. And that’s why, five years ago, we put the wheels in motion to establish a provincial screening program, targeting the general population.
“Simply put, not enough people are being screened for colon cancer in the province,” says Dr. Jerry McGrath, Medical Director of the colon cancer screening program. “As physicians, we conduct screening tests to find diseases at an earlier, preventable stage. In the case of colon cancer, this means we want to find cancers before they spread through the body or even at an earlier stage when they are small mushroom like growths called polyps.
“The FIT test helps us do this. Early detection is the key.”
The Newfoundland and Labrador Colon Cancer Screening program (NLCCSP) was launched in July of 2012 in the Western Health Region – offering screening to those of average or normal risk for this form of cancer. Over the next three years, the program expanded to Central Health, Labrador-Grenfell Health and this past July, the program was launched in Eastern Health, making FIT available to all residents in the province who are 50-74 years of age.
So what is FIT and what does it have to do with colorectal cancer?
FIT is the home-based screening test offered to screen for colorectal cancer and stands for Fecal Immunochemical Test. Easy, pain-free – and free – the test is done in the privacy of one’s own home and seeks to detect microscopic amounts of blood in stool samples.
FIT testing is somewhat different than the traditional stool based testing or screening, because:
- The test runs through an analyzer and produces a quantitative result that is interpreted as either positive or negative.
- The test is not influenced by medications or diet.
- The test has a relatively long shelf life and can be frozen, thawed and tested. Thus, the test can easily be shipped from any portion of the province at any time of the year!
Individuals who sign up to participate in the screening program will receive the test kit in their mail boxes. When samples are collected, they return the completed test through the mail for analysis at the biochemistry lab at St. Clare’s Mercy Hospital.
Individuals with a negative result are automatically re-screened in two years, while those with a positive result are navigated to a follow-up colonoscopy in the screening program.
A timely approach
The screening program aimed to be fully provincial in three years. And, as manager, I’m delighted to say we succeeded – to the day! The fourth and final phase of the program was implemented in Eastern Health on July 23, 2015.
What made it possible? The answer, like the test kit, is easy, but its impact is great. No one person can make it all happen. The key to success was people, relationships and desire.
I believed right from the start that the screening program needed to find people to build and implement the program, form positive relationships throughout the province, and find individuals with the desire to champion the program and effect change in the approach to screening for colorectal cancer.
The colon screening program was based on delivering positive outcomes – and placing the needs of the patient first. The nurses and clerks in the program designed standards and protocols that ensured participants receive care that’s quick and effective.
The program was keen to provide open, yet appropriate access, while keeping those in the patient’s circle of care, such as the family doctor, informed of the process and outcome for their patient. It recognized that each person’s role within the program is crucial for a patient to move smoothly through the program, and that they’re all connected inside the screening process.
External relationships were also key to building the colon screening program. The Cancer Care Program within Eastern Health is responsible for administering the colon screening program. However, a screening test is only effective if it’s interpreted properly.
From the beginning, the Laboratory Medicine Program and the screening program worked hand in hand. The Biochemistry staff at St. Clare’s Mercy Hospital in St. John’s process every FIT kit for the screening program.
As it grew towards a full provincial program, our screening staff and the lab staff worked together on challenges such as increased volume and reporting so that screening program clients received timely test results.
Once the laboratory determines a positive test result, follow-up work needs to occur outside the screening program – and within the regional health authorities: Western, Central, Eastern and Labrador-Grenfell Health.
Implementation into each regional health authority (RHA) brought its own unique set of tweaks and adjustments to make the program work in each area of the province. Within each regional implementation phase, the importance of relations-building was reinforced.
But again, our program formed great relationships and partnerships with endoscopy units and primary care clinics throughout the province. All the RHAs were only too happy to help – and staff and physicians in each one went above and beyond to make the colon screening program a success:
- Endoscopy staff in Western Health took a keen interest in the program outcomes, as theirs was the screening program’s first site. In addition, the staff at the breast cancer screening program in Western were key to helping spread the importance of colon screening and encouraging participation.
- Nurses from the community clinics in Labrador-Grenfell Health sent lists of participants who wanted to take part in the screening program and helped arrange follow-up care with staff at the screening program.
- Clerks in Central Health book FIT positive colonoscopies and stay in constant communication on appointment times with the screening program.
“The colon screening program has provided our patients on the north coast of Labrador the opportunity to access colorectal cancer screening in their home community without the worry of travelling out,” says James Feltham, the community clinic nurse in Hopedale.
“The FIT kit results are provided to the patients in a timely manner, allowing the regional nurses to partnership with the colon screening program to help navigate those who are positive to a colonoscopy.”
And then came Eastern Health – as the program moved to the province’s largest health authority, with the largest population. The volume of requests for test kits and, in turn, any follow-up colonoscopies, would be the biggest challenge the program would face.
But once again, we proved the benefits of great working relationships – that when groups are focused on one goal, success can be achieved. The endoscopy program at Eastern Health worked closely with the screening program to work out solutions.
Part of this involved extensive renovations of the St. Clare’s Endoscopy suite to prepare for more colonoscopies. But health care is a 24-7 operation, and the other scope procedures had to keep going, resulting in the physicians and staff working ‘around construction’ to continue providing excellent patient care.
So what have all the timelines, tests and teamwork really meant, when it comes to the health of our Newfoundlanders and Labradorians?
- To date, 12,200 have requested a home screening FIT kit;
- Of that number, close to 9,400 completed the test and returned it for analysis; and
- Approximately 1,760 individuals have gone on to receive further investigation to include colonoscopy, as a result of a positive home screening test, and received further treatment, as required.
“As this program expands over the next few years we will see even greater results, added Dr. McGrath. “We’ll see fewer hospitalizations, lower surgery rates, and a reduced need for chemotherapy and radiation for the treatment of colon cancer.
“Most importantly, people who are detected at an early stage will lead longer and more productive lives.”
As the manager of the colon cancer screening program for the past five years, I can honestly say that for me, its development has reinforced the saying: ‘the whole is only as good as the sum of its parts.’
The staff at the colon screening program are also a big reason why the program has succeeded to date. They are dedicated to the program, and always approach their work from the patient perspective.
Without many different parts of the health system, working as one unit, the colon screening program would never have reached its goals with respect to implementation, would not have enjoyed its success to date – or provided the public the benefits of ‘getting FIT!’ ■
This story was written by Scott Antle, Manager of the NL Colon Cancer Screening Program.