Exploring the Implementation for Early Screening, Diagnosis, and Treatment of Colorectal Cancer in China: A Case Study in Tongling City

Abstract

Background: In 2015, colorectal cancer (CRC) constituted approximately 10% of all global cancer incidences, with China witnessing 388,000 new cases. Initiated in 2006, the Central Government's Rural Cancer Screening and Early Diagnosis and Treatment Project represents a significant national health initiative, extending across 252 sites, including Tongling City. Tongling People's Hospital is responsible for overseeing this project, implementing a digital platform for managing the participants’ screening data, electronic colonoscopy findings, pathological diagnoses, and follow-up treatments. This study seeks to: (i) elucidate the processes of implementation of the program; (ii) examine the challenges faced in the administration of this project; and (iii) offer policy recommendations.Method: This study used mixed methods. The quantitative data on CRC is derived from the registry data of Tongling People’s Hospital. The quantitative data was designed to elucidate sociodemographic characteristics of the study population, ascertain the prevalence of positive cases, and identify factors associated with an elevated risk of CRC. The qualitative method encompasses conducting individual interviews with village doctors, who guide participants aged 40-74 through demographic surveys prior to administering fecal immunochemical tests (FIT) if they are at high risk of CRC and focus group interviews with hospital managers. It was implemented to examine the challenging experiences, alongside gathering recommendations. Results: In the quantitative analysis, FIT was administered to 8,768 participants, resulting in 1,484 positive findings. Female participants exhibited a significantly higher rate of positive results in comparison to their male counterparts, with this discrepancy achieving statistical significance (p=0.015). An elevated positivity rate was observed among the older age cohorts, particularly those aged 65 to 75 years, a difference that was also statistically significant (p=0.003). Qualitative analysis highlighted several challenges: (i) Incomplete integration of diagnostics and follow-up data into the digital platform, limited to questionnaires and preliminary screening; (ii) Financial constraints and the pandemic's impact hindering research expansion, especially male participation; (iii) Regulatory deficiencies in data quality assurance, including insufficient preliminary screening quality control, the necessity for enhanced training of village doctors; (iv) Obstacles in integrating digital platforms with outdated medical infrastructure, primarily due to the pathology information system's inability to effectively synchronize pathology reports with patient data. In the individual interviews, hospital managers articulated the following recommendations: (i) Enhancing public awareness; (ii) Applying for People’s Livelihood Projects; (iii) Upgrading the capabilities of electronic colonoscopy and establishing performance metrics for quality assurance. Conclusion: The study reveals the implementation, processes, challenges of the CRC Screening and Early Diagnosis and Treatment Project in Tongling city. The policy recommendations made by the researcher are: (i) Enhance financial subsidies for the screening platform, alongside the establishment of contingency reserves; (ii) Use a performance-based remuneration framework that could bolster the data quality furnished by village doctors; (iii) Build communication with provincial organizations; (iv) Boost male participation by strategies such as adaptable scheduling options and mobile screening units. Future research should focus on enhancing financial support, data quality, participant engagement, and educational initiatives.