Dr. Knudsen received a BS with Distinction in policy analysis from Cornell University and a PhD in Health Policy from Harvard University. While at Harvard, Amy was the recipient of a Cancer Prevention Training Grant from the National Cancer Institute (NCI) and a Dissertation Completion Fellowship from Harvard University. She completed a NCI-funded post-doctoral fellowship in the Dana-Farber/Harvard Cancer Center Program in Cancer Outcomes Research Training (PCORT). She has worked for health-economics consulting firms where she developed decision-analytic models to assess the lifetime health and economic consequences of obesity and the benefits of weight loss.
Dr. Knudsen’s career goal is to improve cancer outcomes by identifying the most effective and cost-effective options for prevention, screening, and treatment. Her research focuses on the use of disease simulation models to inform cancer control policies. Her work to date has focused on colorectal cancer, the second most common cause of cancer death in the US. She developed and programmed a computer model, SimCRC, that simulates the natural history of colorectal cancer among the US population over time and incorporates the effects of prevention, screening, and treatment interventions. SimCRC has been used to inform both state- and national screening coverage decisions and guidelines. Dr. Knudsen’s research aims to evaluate how existing and emerging screening methodologies can best be used to minimize the burden of colorectal cancer.
Selected Publications
Knudsen, Amy; Rutter, Carolyn M; Meester, Reinier G S; Lansdorp-Vogelaar, Iris; Zauber, Ann G; Kuntz, Karen M
Colorectal Cancer Screening in Young Adults. Journal Article
In: Annals of internal medicine, vol. 174, no. 7, pp. 1039–1040, 2021, ISSN: 1539-3704, ().
@article{Knudsen2021a,
title = {Colorectal Cancer Screening in Young Adults.},
author = {Amy Knudsen and Carolyn M Rutter and Reinier G S Meester and Iris Lansdorp-Vogelaar and Ann G Zauber and Karen M Kuntz},
url = {https://pubmed.ncbi.nlm.nih.gov/34280341/},
doi = {10.7326/L21-0245},
issn = {1539-3704},
year = {2021},
date = {2021-07-01},
journal = {Annals of internal medicine},
volume = {174},
number = {7},
pages = {1039--1040},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Knudsen, Amy; Rutter, Carolyn M.; Peterse, Elisabeth F. P.; Lietz, Anna; Seguin, Claudia; Meester, Reinier G. S.; Perdue, Leslie A.; Lin, Jennifer S.; Siegel, Rebecca L.; Doria-Rose, V. Paul; Feuer, Eric J.; Zauber, Ann G.; Kuntz, Karen M.; Lansdorp-Vogelaar, Iris
Colorectal Cancer Screening: An Updated Modeling Study for the US Preventive Services Task Force Journal Article
In: JAMA, vol. 325, no. 19, pp. 1998-2011, 2021, ISSN: 0098-7484, ().
@article{knudsen2021,
title = {Colorectal Cancer Screening: An Updated Modeling Study for the US Preventive Services Task Force},
author = {Amy Knudsen and Carolyn M. Rutter and Elisabeth F. P. Peterse and Anna Lietz and Claudia Seguin and Reinier G. S. Meester and Leslie A. Perdue and Jennifer S. Lin and Rebecca L. Siegel and V. Paul Doria-Rose and Eric J. Feuer and Ann G. Zauber and Karen M. Kuntz and Iris Lansdorp-Vogelaar},
url = {https://doi.org/10.1001/jama.2021.5746},
doi = {10.1001/jama.2021.5746},
issn = {0098-7484},
year = {2021},
date = {2021-05-01},
journal = {JAMA},
volume = {325},
number = {19},
pages = {1998-2011},
abstract = {The US Preventive Services Task Force (USPSTF) is updating its 2016 colorectal cancer screening recommendations.To provide updated model-based estimates of the benefits, burden, and harms of colorectal cancer screening strategies and to identify strategies that may provide an efficient balance of life-years gained (LYG) from screening and colonoscopy burden to inform the USPSTF.Comparative modeling study using 3 microsimulation models of colorectal cancer screening in a hypothetical cohort of 40-year-old US individuals at average risk of colorectal cancer.Screening from ages 45, 50, or 55 years to ages 70, 75, 80, or 85 years with fecal immunochemical testing (FIT), multitarget stool DNA testing, flexible sigmoidoscopy alone or with FIT, computed tomography colonography, or colonoscopy. All persons with an abnormal noncolonoscopy screening test result were assumed to undergo follow-up colonoscopy. Screening intervals varied by test. Full adherence with all procedures was assumed.Estimated LYG relative to no screening (benefit), lifetime number of colonoscopies (burden), number of complications from screening (harms), and balance of incremental burden and benefit (efficiency ratios). Efficient strategies were those estimated to require fewer additional colonoscopies per additional LYG relative to other strategies.Estimated LYG from screening strategies ranged from 171 to 381 per 1000 40-year-olds. Lifetime colonoscopy burden ranged from 624 to 6817 per 1000 individuals, and screening complications ranged from 5 to 22 per 1000 individuals. Among the 49 strategies that were efficient options with all 3 models, 41 specified screening beginning at age 45. No single age to end screening was predominant among the efficient strategies, although the additional LYG from continuing screening after age 75 were generally small. With the exception of a 5-year interval for computed tomography colonography, no screening interval predominated among the efficient strategies for each modality. Among the strategies highlighted in the 2016 USPSTF recommendation, lowering the age to begin screening from 50 to 45 years was estimated to result in 22 to 27 additional LYG, 161 to 784 additional colonoscopies, and 0.1 to 2 additional complications per 1000 persons (ranges are across screening strategies, based on mean estimates across models). Assuming full adherence, screening outcomes and efficient strategies were similar by sex and race and across 3 scenarios for population risk of colorectal cancer.This microsimulation modeling analysis suggests that screening for colorectal cancer with stool tests, endoscopic tests, or computed tomography colonography starting at age 45 years provides an efficient balance of colonoscopy burden and life-years gained.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The US Preventive Services Task Force (USPSTF) is updating its 2016 colorectal cancer screening recommendations.To provide updated model-based estimates of the benefits, burden, and harms of colorectal cancer screening strategies and to identify strategies that may provide an efficient balance of life-years gained (LYG) from screening and colonoscopy burden to inform the USPSTF.Comparative modeling study using 3 microsimulation models of colorectal cancer screening in a hypothetical cohort of 40-year-old US individuals at average risk of colorectal cancer.Screening from ages 45, 50, or 55 years to ages 70, 75, 80, or 85 years with fecal immunochemical testing (FIT), multitarget stool DNA testing, flexible sigmoidoscopy alone or with FIT, computed tomography colonography, or colonoscopy. All persons with an abnormal noncolonoscopy screening test result were assumed to undergo follow-up colonoscopy. Screening intervals varied by test. Full adherence with all procedures was assumed.Estimated LYG relative to no screening (benefit), lifetime number of colonoscopies (burden), number of complications from screening (harms), and balance of incremental burden and benefit (efficiency ratios). Efficient strategies were those estimated to require fewer additional colonoscopies per additional LYG relative to other strategies.Estimated LYG from screening strategies ranged from 171 to 381 per 1000 40-year-olds. Lifetime colonoscopy burden ranged from 624 to 6817 per 1000 individuals, and screening complications ranged from 5 to 22 per 1000 individuals. Among the 49 strategies that were efficient options with all 3 models, 41 specified screening beginning at age 45. No single age to end screening was predominant among the efficient strategies, although the additional LYG from continuing screening after age 75 were generally small. With the exception of a 5-year interval for computed tomography colonography, no screening interval predominated among the efficient strategies for each modality. Among the strategies highlighted in the 2016 USPSTF recommendation, lowering the age to begin screening from 50 to 45 years was estimated to result in 22 to 27 additional LYG, 161 to 784 additional colonoscopies, and 0.1 to 2 additional complications per 1000 persons (ranges are across screening strategies, based on mean estimates across models). Assuming full adherence, screening outcomes and efficient strategies were similar by sex and race and across 3 scenarios for population risk of colorectal cancer.This microsimulation modeling analysis suggests that screening for colorectal cancer with stool tests, endoscopic tests, or computed tomography colonography starting at age 45 years provides an efficient balance of colonoscopy burden and life-years gained.
Peterse, Elisabeth F. P.; Meester, Reinier G. S.; Jonge, Lucie; Omidvari, Amir-Houshang; Alarid-Escudero, Fernando; Knudsen, Amy; Zauber, Ann G.; Lansdorp-Vogelaar, Iris
Comparing the cost-effectiveness of innovative colorectal cancer screening tests. Journal Article
In: Journal of the National Cancer Institute, vol. 113, no. 2, pp. 154-161, 2021, ISSN: 1460-2105, ().
@article{Peterse2020,
title = {Comparing the cost-effectiveness of innovative colorectal cancer screening tests.},
author = {Elisabeth F. P. Peterse and Reinier G. S. Meester and Lucie Jonge and Amir-Houshang Omidvari and Fernando Alarid-Escudero and Amy Knudsen and Ann G. Zauber and Iris Lansdorp-Vogelaar},
url = {https://pubmed.ncbi.nlm.nih.gov/32761199/},
doi = {10.1093/jnci/djaa103},
issn = {1460-2105},
year = {2021},
date = {2021-02-01},
journal = {Journal of the National Cancer Institute},
volume = {113},
number = {2},
pages = {154-161},
abstract = {Colorectal cancer (CRC) screening with colonoscopy and the fecal immunochemical test (FIT) is underutilized. Innovative tests could increase screening acceptance. This study determined which of the available alternatives is most promising from a cost-effectiveness perspective. The previously-validated MISCAN-Colon model was used to evaluate the cost-effectiveness of screening with capsule endoscopy every 5 or 10 years, computed tomographic colonography (CTC) every 5 years, the multi-target stool DNA (mtSDNA) test every 1 or 3 years, and the methylated SEPT9 DNA plasma assay (mSEPT9) every 1 or 2 years. We also compared these strategies to annual FIT screening and colonoscopy screening every 10 years. Quality-adjusted life-years gained (QALYG), number of colonoscopies, and incremental cost-effectiveness ratios (ICERs) were projected. We assumed a willingness-to-pay threshold of $100,000 per QALYG. Among the alternative tests, CTC every 5 years, annual mSEPT9 and annual mtSDNA screening had ICERs of $1,092, $63,253 and $214,974 per QALYG, respectively. Other screening strategies were more costly and less effective than (a combination of) these three. Under the assumption of perfect adherence, annual mSEPT9 screening resulted in more QALYG, CRC cases averted and CRC deaths averted than annual FIT screening, but led to a high rate of colonoscopy referral (51% after 3 years, 69% after 5 years). The alternative tests were not cost-effective compared to FIT and colonoscopy. This study suggests that for individuals not willing to participate in FIT or colonoscopy screening, mSEPT9 is the test of choice if the high colonoscopy referral rate is acceptable to them.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Colorectal cancer (CRC) screening with colonoscopy and the fecal immunochemical test (FIT) is underutilized. Innovative tests could increase screening acceptance. This study determined which of the available alternatives is most promising from a cost-effectiveness perspective. The previously-validated MISCAN-Colon model was used to evaluate the cost-effectiveness of screening with capsule endoscopy every 5 or 10 years, computed tomographic colonography (CTC) every 5 years, the multi-target stool DNA (mtSDNA) test every 1 or 3 years, and the methylated SEPT9 DNA plasma assay (mSEPT9) every 1 or 2 years. We also compared these strategies to annual FIT screening and colonoscopy screening every 10 years. Quality-adjusted life-years gained (QALYG), number of colonoscopies, and incremental cost-effectiveness ratios (ICERs) were projected. We assumed a willingness-to-pay threshold of $100,000 per QALYG. Among the alternative tests, CTC every 5 years, annual mSEPT9 and annual mtSDNA screening had ICERs of $1,092, $63,253 and $214,974 per QALYG, respectively. Other screening strategies were more costly and less effective than (a combination of) these three. Under the assumption of perfect adherence, annual mSEPT9 screening resulted in more QALYG, CRC cases averted and CRC deaths averted than annual FIT screening, but led to a high rate of colonoscopy referral (51% after 3 years, 69% after 5 years). The alternative tests were not cost-effective compared to FIT and colonoscopy. This study suggests that for individuals not willing to participate in FIT or colonoscopy screening, mSEPT9 is the test of choice if the high colonoscopy referral rate is acceptable to them.
Rutter, Carolyn M.; Knudsen, Amy; Lin, Jennifer S.; Bouskill, Kathryn E.
Black and White Differences in Colorectal Cancer Screening and Screening Outcomes: A Narrative Review. Journal Article
In: Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, vol. 30, no. 1, pp. 3-12, 2021, ISSN: 1538-7755, ().
@article{Rutter2020,
title = {Black and White Differences in Colorectal Cancer Screening and Screening Outcomes: A Narrative Review.},
author = {Carolyn M. Rutter and Amy Knudsen and Jennifer S. Lin and Kathryn E. Bouskill},
url = {https://pubmed.ncbi.nlm.nih.gov/33144285/},
doi = {10.1158/1055-9965.EPI-19-1537},
issn = {1538-7755},
year = {2021},
date = {2021-01-01},
journal = {Cancer epidemiology, biomarkers \& prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology},
volume = {30},
number = {1},
pages = {3-12},
abstract = {Racial disparities in colorectal cancer (CRC) incidence are widely documented. There are two potential mechanisms for these disparities: differences in access to screening, including screening follow-up, and differences in underlying risk of CRC. We reviewed the literature for evidence of these two mechanisms. We show that higher CRC incidence in blacks relative to whites emerged only after the dissemination of screening and describe evidence of racial disparities in screening rates. In contrast to the strong evidence for differences in CRC screening utilization, there is limited evidence for racial differences in adenoma prevalence. In general, black and white patients who are screened have similar adenoma prevalence, though there is some evidence that advanced adenomas and adenomas in the proximal colon are somewhat more likely in black than white patients. We conclude that higher rates of CRC incidence among black patients are primarily driven by lower rates of CRC screening. Our findings highlight the need to increase black patients' access to quality screening to reduce CRC incidence and mortality.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Racial disparities in colorectal cancer (CRC) incidence are widely documented. There are two potential mechanisms for these disparities: differences in access to screening, including screening follow-up, and differences in underlying risk of CRC. We reviewed the literature for evidence of these two mechanisms. We show that higher CRC incidence in blacks relative to whites emerged only after the dissemination of screening and describe evidence of racial disparities in screening rates. In contrast to the strong evidence for differences in CRC screening utilization, there is limited evidence for racial differences in adenoma prevalence. In general, black and white patients who are screened have similar adenoma prevalence, though there is some evidence that advanced adenomas and adenomas in the proximal colon are somewhat more likely in black than white patients. We conclude that higher rates of CRC incidence among black patients are primarily driven by lower rates of CRC screening. Our findings highlight the need to increase black patients' access to quality screening to reduce CRC incidence and mortality.
Seguin, Claudia; Lietz, Anna; Wright, Jason D.; Wright, Alexi; Knudsen, Amy; Pandharipande, Pari
Surveillance in Older Women With Incidental Ovarian Cysts: Maximal Projected Benefits by Age and Comorbidity Level. Journal Article
In: Journal of the American College of Radiology : JACR, vol. 18, no. 1 PT A, pp. 10-18, 2021, ISSN: 1558-349X, ().
@article{Seguin2020,
title = {Surveillance in Older Women With Incidental Ovarian Cysts: Maximal Projected Benefits by Age and Comorbidity Level.},
author = {Claudia Seguin and Anna Lietz and Jason D. Wright and Alexi Wright and Amy Knudsen and Pari Pandharipande},
url = {https://pubmed.ncbi.nlm.nih.gov/33096089/},
doi = {10.1016/j.jacr.2020.09.048},
issn = {1558-349X},
year = {2021},
date = {2021-01-01},
journal = {Journal of the American College of Radiology : JACR},
volume = {18},
number = {1 PT A},
pages = {10-18},
abstract = {The aim of this study was to estimate effects on life expectancy (LE) of imaging-based ovarian surveillance after detection of incidental postmenopausal ovarian cysts, under different assumptions of patient age, comorbidity level, and cancer risk and detection. A decision-analytic Markov model was developed to estimate LE benefits. Hypothetical cohorts of postmenopausal women with simple ovarian cysts were evaluated, with varied age (66-80 years) and comorbidity level (none, mild, moderate, severe). For each cohort, imaging "follow-up" (2 years) and "no-follow-up" strategies were compared. Consistent with current evidence, increased cancer risk in patients with cysts was not assumed; however, incident ovarian cancers could be detected during follow-up. To estimate theoretical maximal LE gains from follow-up, perfect ovarian cancer detection and treatment during follow-up were assumed. This and other key assumptions were varied in sensitivity analysis. Projected LE gains from follow-up were limited. For 66-, 70-, 75-, and 80-year-old women with no comorbidities, LE gains were 5.1, 5.1, 4.5, and 3.7 days; with severe comorbidities, they were 3.5, 3.2, 2.7, and 2.1 days. With sensitivity of 50% for cancer detection, they were 3.7 days for 66-year-old women with no comorbidities and 1.3 days for 80-year-old women with severe comorbidities. When cancer risk for women with cysts was assumed to be elevated (1.1 times average risk), LE gains increased only modestly (5.6 and 2.3 days for analogous cohorts). Even in the circumstance of perfect ovarian cancer detection and treatment, surveillance of postmenopausal women (≥66 years of age) with simple cysts affords limited benefits, particularly in women with advanced age and comorbidities.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The aim of this study was to estimate effects on life expectancy (LE) of imaging-based ovarian surveillance after detection of incidental postmenopausal ovarian cysts, under different assumptions of patient age, comorbidity level, and cancer risk and detection. A decision-analytic Markov model was developed to estimate LE benefits. Hypothetical cohorts of postmenopausal women with simple ovarian cysts were evaluated, with varied age (66-80 years) and comorbidity level (none, mild, moderate, severe). For each cohort, imaging "follow-up" (2 years) and "no-follow-up" strategies were compared. Consistent with current evidence, increased cancer risk in patients with cysts was not assumed; however, incident ovarian cancers could be detected during follow-up. To estimate theoretical maximal LE gains from follow-up, perfect ovarian cancer detection and treatment during follow-up were assumed. This and other key assumptions were varied in sensitivity analysis. Projected LE gains from follow-up were limited. For 66-, 70-, 75-, and 80-year-old women with no comorbidities, LE gains were 5.1, 5.1, 4.5, and 3.7 days; with severe comorbidities, they were 3.5, 3.2, 2.7, and 2.1 days. With sensitivity of 50% for cancer detection, they were 3.7 days for 66-year-old women with no comorbidities and 1.3 days for 80-year-old women with severe comorbidities. When cancer risk for women with cysts was assumed to be elevated (1.1 times average risk), LE gains increased only modestly (5.6 and 2.3 days for analogous cohorts). Even in the circumstance of perfect ovarian cancer detection and treatment, surveillance of postmenopausal women (≥66 years of age) with simple cysts affords limited benefits, particularly in women with advanced age and comorbidities.
DeYoreo, Maria; Lansdorp-Vogelaar, Iris; Knudsen, Amy; Kuntz, Karen M.; Zauber, Ann G.; Rutter, Carolyn M.
Validation of Colorectal Cancer Models on Long-Term Outcomes from a Randomized Controlled Trial. Journal Article
In: Medical decision making : an international journal of the Society for Medical Decision Making, vol. 40, no. 8, pp. 1034-1040, 2020, ISSN: 1552-681X, ().
@article{DeYoreo2020,
title = {Validation of Colorectal Cancer Models on Long-Term Outcomes from a Randomized Controlled Trial.},
author = {Maria DeYoreo and Iris Lansdorp-Vogelaar and Amy Knudsen and Karen M. Kuntz and Ann G. Zauber and Carolyn M. Rutter},
url = {https://pubmed.ncbi.nlm.nih.gov/33078673/},
doi = {10.1177/0272989X20961095},
issn = {1552-681X},
year = {2020},
date = {2020-11-01},
journal = {Medical decision making : an international journal of the Society for Medical Decision Making},
volume = {40},
number = {8},
pages = {1034-1040},
abstract = {Microsimulation models are often used to predict long-term outcomes and guide policy decisions regarding cancer screening. The United Kingdom Flexible Sigmoidoscopy Screening (UKFSS) Trial examines a one-time intervention of flexible sigmoidoscopy that was implemented before a colorectal cancer (CRC) screening program was established. Long-term study outcomes, now a full 17 y following randomization, have been published. We use the outcomes from this trial to validate 3 microsimulation models for CRC to long-term study outcomes. We find that 2 of 3 models accurately predict the relative effect of screening (the hazard ratios) on CRC-specific incidence 17 y after screening. We find that all 3 models yield predictions of the relative effect of screening on CRC incidence and mortality (i.e., the hazard ratios) that are reasonably close to the UKFSS results. Two of the 3 models accurately predict the relative reduction in CRC incidence 17 y after screening. One model accurately predicted the absolute incidence and mortality rates in the screened group. The models differ in their estimates related to adenoma detection at screening. Although high-quality screening results help to inform models, trials are expensive, last many years, and can be complicated by ethical issues and technological changes across the duration of the trial. Thus, well-calibrated and validated models are necessary to predict outcomes for which data are not available. The results from this validation demonstrate the utility of models in predicting long-term outcomes and in collaborative modeling to account for uncertainty.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Microsimulation models are often used to predict long-term outcomes and guide policy decisions regarding cancer screening. The United Kingdom Flexible Sigmoidoscopy Screening (UKFSS) Trial examines a one-time intervention of flexible sigmoidoscopy that was implemented before a colorectal cancer (CRC) screening program was established. Long-term study outcomes, now a full 17 y following randomization, have been published. We use the outcomes from this trial to validate 3 microsimulation models for CRC to long-term study outcomes. We find that 2 of 3 models accurately predict the relative effect of screening (the hazard ratios) on CRC-specific incidence 17 y after screening. We find that all 3 models yield predictions of the relative effect of screening on CRC incidence and mortality (i.e., the hazard ratios) that are reasonably close to the UKFSS results. Two of the 3 models accurately predict the relative reduction in CRC incidence 17 y after screening. One model accurately predicted the absolute incidence and mortality rates in the screened group. The models differ in their estimates related to adenoma detection at screening. Although high-quality screening results help to inform models, trials are expensive, last many years, and can be complicated by ethical issues and technological changes across the duration of the trial. Thus, well-calibrated and validated models are necessary to predict outcomes for which data are not available. The results from this validation demonstrate the utility of models in predicting long-term outcomes and in collaborative modeling to account for uncertainty.
Abuelo, Carolina; Ashburner, Jeffrey M.; Atlas, Steven J.; Knudsen, Amy; Morrill, James; Corona, Patricia; Shtasel, Derri; Percac-Lima, Sanja
Colorectal Cancer Screening Patient Navigation for Patients with Mental Illness and/or Substance Use Disorder: Pilot Randomized Control Trial. Journal Article
In: Journal of dual diagnosis, vol. 16, no. 4, pp. 438-446, 2020, ISSN: 1550-4271, ().
@article{Abuelo2020,
title = {Colorectal Cancer Screening Patient Navigation for Patients with Mental Illness and/or Substance Use Disorder: Pilot Randomized Control Trial.},
author = {Carolina Abuelo and Jeffrey M. Ashburner and Steven J. Atlas and Amy Knudsen and James Morrill and Patricia Corona and Derri Shtasel and Sanja Percac-Lima},
url = {https://pubmed.ncbi.nlm.nih.gov/32762637/},
doi = {10.1080/15504263.2020.1802542},
issn = {1550-4271},
year = {2020},
date = {2020-08-01},
journal = {Journal of dual diagnosis},
volume = {16},
number = {4},
pages = {438-446},
abstract = {Colorectal cancer (CRC) is the second leading cause of cancer death in the US. Screening has decreased CRC mortality. However, disadvantaged patients, particularly those with mental illness or substance use disorder (SUD), are less likely to be screened. The aim of this trial was to evaluate the impact of a patient navigation program on CRC screening in patients with mental illness and/or SUD. A pilot randomized nonblinded controlled trial was conducted from January to June 2017 in an urban community health center serving a low-income population. We randomized 251 patients aged 50-74 years with mental illness and/or SUD diagnosis overdue for CRC screening to intervention ( = 126) or usual care ( = 125) stratified by mental illness, SUD, or dual diagnosis. Intervention group patients received a letter followed by a phone call from patient navigators. Navigators helped patients overcome their individual barriers to CRC screening including: education, scheduling, explanation of bowel preparation, lack of transportation or accompaniment to appointments. If patient refused colonoscopy, navigators offered fecal occult blood testing. The main measure was proportion of patients completing CRC screening in intervention and usual care groups. Navigators contacted 85 patients (67%) in the intervention group and 26 declined to participate. In intention-to treat analysis, more patients in the intervention group received CRC screening than in the usual care group, 19% versus 10.4% ( = .04). Among 56 intervention patients who received navigation, 19 completed screening (33.9% versus 10.4% in the control group, = .001). In the subgroup of patients with SUD, 20% in the intervention group were screened compared to none in the usual care group ( = .05). A patient navigation program improved CRC screening rates in patients with mental illness and/or SUD. Larger studies in diverse care settings are needed to demonstrate generalizability and explore which modality of CRC screening is most acceptable and which navigator activities are most effective for this vulnerable population. 2016P001322.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Colorectal cancer (CRC) is the second leading cause of cancer death in the US. Screening has decreased CRC mortality. However, disadvantaged patients, particularly those with mental illness or substance use disorder (SUD), are less likely to be screened. The aim of this trial was to evaluate the impact of a patient navigation program on CRC screening in patients with mental illness and/or SUD. A pilot randomized nonblinded controlled trial was conducted from January to June 2017 in an urban community health center serving a low-income population. We randomized 251 patients aged 50-74 years with mental illness and/or SUD diagnosis overdue for CRC screening to intervention ( = 126) or usual care ( = 125) stratified by mental illness, SUD, or dual diagnosis. Intervention group patients received a letter followed by a phone call from patient navigators. Navigators helped patients overcome their individual barriers to CRC screening including: education, scheduling, explanation of bowel preparation, lack of transportation or accompaniment to appointments. If patient refused colonoscopy, navigators offered fecal occult blood testing. The main measure was proportion of patients completing CRC screening in intervention and usual care groups. Navigators contacted 85 patients (67%) in the intervention group and 26 declined to participate. In intention-to treat analysis, more patients in the intervention group received CRC screening than in the usual care group, 19% versus 10.4% ( = .04). Among 56 intervention patients who received navigation, 19 completed screening (33.9% versus 10.4% in the control group, = .001). In the subgroup of patients with SUD, 20% in the intervention group were screened compared to none in the usual care group ( = .05). A patient navigation program improved CRC screening rates in patients with mental illness and/or SUD. Larger studies in diverse care settings are needed to demonstrate generalizability and explore which modality of CRC screening is most acceptable and which navigator activities are most effective for this vulnerable population. 2016P001322.
Meester, Reinier G. S.; Lansdorp-Vogelaar, Iris; Winawer, Sidney J.; Zauber, Ann G.; Knudsen, Amy; Ladabaum, Uri
Intensity of Surveillance for Patients With Colorectal Adenomas. Journal Article
In: Annals of internal medicine, vol. 172, pp. 442, 2020, ISSN: 1539-3704, ().
@article{Meester2020a,
title = {Intensity of Surveillance for Patients With Colorectal Adenomas.},
author = {Reinier G. S. Meester and Iris Lansdorp-Vogelaar and Sidney J. Winawer and Ann G. Zauber and Amy Knudsen and Uri Ladabaum},
url = {https://pubmed.ncbi.nlm.nih.gov/32176909/},
doi = {10.7326/L19-0829},
issn = {1539-3704},
year = {2020},
date = {2020-03-01},
urldate = {2020-03-01},
journal = {Annals of internal medicine},
volume = {172},
pages = {442},
keywords = {},
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Meester, Reinier G. S.; Lansdorp-Vogelaar, Iris; Winawer, Sidney J.; Zauber, Ann G.; Knudsen, Amy; Ladabaum, Uri
Intensity of Surveillance for Patients With Colorectal Adenomas. Journal Article
In: Annals of internal medicine, vol. 172, pp. 442, 2020, ISSN: 1539-3704, ().
@article{Meester2020,
title = {Intensity of Surveillance for Patients With Colorectal Adenomas.},
author = {Reinier G. S. Meester and Iris Lansdorp-Vogelaar and Sidney J. Winawer and Ann G. Zauber and Amy Knudsen and Uri Ladabaum},
url = {https://www.ncbi.nlm.nih.gov/pubmed/32176909},
doi = {10.7326/L19-0829},
issn = {1539-3704},
year = {2020},
date = {2020-03-01},
urldate = {2020-03-01},
journal = {Annals of internal medicine},
volume = {172},
pages = {442},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Meester, Reinier G S; Lansdorp-Vogelaar, Iris; Winawer, Sidney J; Zauber, Ann G; Knudsen, Amy; Ladabaum, Uri
High-Intensity Versus Low-Intensity Surveillance for Patients With Colorectal Adenomas: A Cost-Effectiveness Analysis. Journal Article
In: Annals of internal medicine, vol. 171, no. 9, pp. 612-622, 2019, ISSN: 1539-3704, ().
@article{Meester2019,
title = {High-Intensity Versus Low-Intensity Surveillance for Patients With Colorectal Adenomas: A Cost-Effectiveness Analysis.},
author = {Reinier G S Meester and Iris Lansdorp-Vogelaar and Sidney J Winawer and Ann G Zauber and Amy Knudsen and Uri Ladabaum},
url = {https://www.ncbi.nlm.nih.gov/pubmed/31546257},
doi = {10.7326/M18-3633},
issn = {1539-3704},
year = {2019},
date = {2019-11-01},
journal = {Annals of internal medicine},
volume = {171},
number = {9},
pages = {612-622},
abstract = {Surveillance of patients with colorectal adenomas has limited long-term evidence to support current practice. To compare the lifetime benefits and costs of high- versus low-intensity surveillance. Microsimulation model. U.S. cancer registry, cost data, and published literature. U.S. patients aged 50, 60, or 70 years with low-risk adenomas (LRAs) (1 to 2 small adenomas) or high-risk adenomas (HRAs) (3 to 10 small adenomas or ≥1 large adenoma) removed after screening with colonoscopy or fecal immunochemical testing (FIT). Lifetime. Societal. No further screening or surveillance, routine screening after 10 years, low-intensity surveillance (10 years after LRA removal and 5 years after HRA removal), and high-intensity surveillance (5 years after LRA removal and 3 years after HRA removal). Colorectal cancer (CRC) incidence and incremental cost-effectiveness. Without surveillance or screening, lifetime CRC incidence for patients aged 50 years was 10.9% after LRA removal and 17.2% after HRA removal at screening colonoscopy. Subsequent colonoscopic screening, low-intensity surveillance, or high-intensity surveillance decreased incidence by 39%, 46% to 48%, and 55% to 56%, respectively. Incidence of CRC and surveillance benefits were higher for adenomas detected at FIT screening and lower for older patients. High-intensity surveillance cost less than $30 000 per quality-adjusted life-year (QALY) gained compared with low-intensity surveillance. High-intensity surveillance cost less than $100 000 per QALY gained in most alternative scenarios for adenoma recurrence, CRC incidence, longevity, quality of life, screening ages, surveillance ages, test performance, disutilities, and cost. Few surveillance outcome data exist. The model suggests that high-intensity surveillance as recommended in the United States provides modest but clinically relevant benefits over low-intensity surveillance at acceptable cost. National Cancer Institute.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Surveillance of patients with colorectal adenomas has limited long-term evidence to support current practice. To compare the lifetime benefits and costs of high- versus low-intensity surveillance. Microsimulation model. U.S. cancer registry, cost data, and published literature. U.S. patients aged 50, 60, or 70 years with low-risk adenomas (LRAs) (1 to 2 small adenomas) or high-risk adenomas (HRAs) (3 to 10 small adenomas or ≥1 large adenoma) removed after screening with colonoscopy or fecal immunochemical testing (FIT). Lifetime. Societal. No further screening or surveillance, routine screening after 10 years, low-intensity surveillance (10 years after LRA removal and 5 years after HRA removal), and high-intensity surveillance (5 years after LRA removal and 3 years after HRA removal). Colorectal cancer (CRC) incidence and incremental cost-effectiveness. Without surveillance or screening, lifetime CRC incidence for patients aged 50 years was 10.9% after LRA removal and 17.2% after HRA removal at screening colonoscopy. Subsequent colonoscopic screening, low-intensity surveillance, or high-intensity surveillance decreased incidence by 39%, 46% to 48%, and 55% to 56%, respectively. Incidence of CRC and surveillance benefits were higher for adenomas detected at FIT screening and lower for older patients. High-intensity surveillance cost less than $30 000 per quality-adjusted life-year (QALY) gained compared with low-intensity surveillance. High-intensity surveillance cost less than $100 000 per QALY gained in most alternative scenarios for adenoma recurrence, CRC incidence, longevity, quality of life, screening ages, surveillance ages, test performance, disutilities, and cost. Few surveillance outcome data exist. The model suggests that high-intensity surveillance as recommended in the United States provides modest but clinically relevant benefits over low-intensity surveillance at acceptable cost. National Cancer Institute.