Health Care Professionals

ColonCancerCheck

Frequently Asked Questions – Pharmacists

Background

  1. What is the ColonCancerCheck program?
  2. Why screen for colorectal cancer?
  3. What is the role of the pharmacist in the ColonCancerCheck program?

Screening

  1. Who is eligible to receive an FOBT kit at a pharmacy?
  2. Who is not eligible to receive an FOBT kit at a pharmacy?
  3. What are the symptoms that may indicate colorectal cancer?
  4. What if an individual is under 50 or over 74 years of age and asks about colorectal cancer screening?
  5. What if the individual has had a colonoscopy within the last 10 years?
  6. What if the individual has a family history of colorectal cancer?
  7. What if the individual already has an FOBT kit?

Results

  1. How will participants who receive their FOBT kits from a pharmacist obtain their results?
  2. Is the pharmacist who dispensed the FOBT kit responsible for follow-up care if a participant has an abnormal (positive) FOBT result?
  3. What does an abnormal (positive) FOBT test result mean?
  4. What if the participant’s first test is inconclusive (a result could not be obtained) or it was rejected for processing and the participant is requesting another kit?
  5. What if a participant presents at the pharmacy asking about their results?

Processes and Remuneration

  1. How can pharmacists obtain FOBT kits?
  2. Where can pharmacists get a laboratory requisition form for FOBT?
  3. What is the PIN (Product Identification Number) for the FOBT kit?
  4. Where can pharmacists order more patient education materials?
  5. What fees can pharmacists claim for colorectal cancer screening?
  6. How does a pharmacist submit an FOBT claim?
  7. What should pharmacists do with the FOBT requisition form?
  8. What is inside the ColonCancerCheck FOBT kit?
  9. How often can colorectal cancer screening services be provided to the same individual?

Further Information

  1. Where can pharmacists go if they have additional questions about the ColonCancerCheck program?

Background

1. What is the ColonCancerCheck program?

In April 2008, the Ministry of Health and Long-Term Care and Cancer Care Ontario launched ColonCancerCheck, Canada's first population-based provincial colorectal cancer screening program. The goals of the ColonCancerCheck program are to reduce deaths from colorectal cancer through an organized screening program and to improve the capacity of health care providers to participate in comprehensive colorectal cancer screening.

Organized screening programs like ColonCancerCheck provide important benefits including the ability to :

2. Why screen for colorectal cancer?

Colorectal cancer is the second leading cause of cancer death in Ontario. In 2011, an estimated 8,100 Ontarians were diagnosed with colorectal cancer and 3,250 died from the disease1. When caught early, there is a 90 percent chance that people with colorectal cancer will be cured, compared with only 12 percent if the cancer is detected at an advanced stage. Regular (repeated) screening using the Fecal Occult Blood Test (FOBT) for individuals aged 50 and older, followed by a colonoscopy for those with an abnormal FOBT, reduces deaths from colorectal cancer by 16 percent. But according to 2009-2010 data, only 27 percent of Ontarians aged 50 to 74 years completed an FOBT in the previous two years.

3. What is the role of the pharmacist in the ColonCancerCheck program?

Pharmacists have an important role in helping Ontarians who do not have a health care provider to access screening for colorectal cancer by :

Pharmacists are not required to recruit eligible individuals to participate in the program.

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Screening

4. Who is eligible to receive an FOBT kit at a pharmacy?

To be eligible to receive an FOBT kit from a pharmacist, an individual must meet all of the following criteria :

If a participant meets all criteria, the pharmacist can provide them with an FOBT kit.

5.  Who is not eligible to receive an FOBT kit at a pharmacy?

Please do not provide FOBT kits to individuals with the following :

Those experiencing one or more of the symptoms described above may require medical attention and must be directed to seek appropriate medical care.

Note: Individuals who regularly use the service of walk-in clinics (e.g. those who obtain monthly blood pressure medications from the same clinic) may obtain their FOBT kits from these clinics to facilitate provision of results and follow-up care.

6. What are the symptoms that may indicate colorectal cancer?

During the early stages of colorectal cancer, there are often no symptoms. This is why screening is important. However, as colorectal cancer progresses, the following symptoms may occur :

It is important to explain that these symptoms do not mean that an individual has colorectal cancer. However if an individual is experiencing one or more of the symptoms they must be directed to seek appropriate medical care from their health care provider.

7. What if an individual is under 50 or over 74 years of age and asks about colorectal cancer screening?

The pharmacist should advise individuals who are under 50 or over 74 years of age that ColonCancerCheck recommends that asymptomatic average risk individuals aged 50 to 74 years of age be screened using the ColonCancerCheck FOBT every two years. This is consistent with clinical guidelines.

The pharmacist should refer the individuals under 50 or over 74 years of age to the ColonCancerCheck website at ontario.ca/coloncancercheck or to his/her health care provider.

8. What if the individual has had a colonoscopy within the last 10 years?

Individuals who have had a colonoscopy within the last 10 years should not be screened using FOBT and should consult with their health care provider about the appropriate follow-up.

If an individual no longer has a health care provider, please refer them to :

9. What if the individual has a family history of colorectal cancer?

People who have a first-degree relative (i.e., parent, sibling or child) with a history of colorectal cancer are at increased risk. For these people, a colonoscopy is recommended beginning at age 50, or 10 years earlier than the age at which their relative was diagnosed (whichever occurs first).

Those at increased risk for colorectal cancer who do not have a health care provider should be referred to the ColonCancerCheck program at 1-866-662-9233. The ColonCancerCheck program can arrange an appointment with a health care provider who is willing to accept participants for referral to follow-up care.

10. What if the individual already has an FOBT kit?

If the individual currently has an FOBT kit, they should be encouraged to use the kit they already have.

 

Results

11. How will participants who receive their FOBT kits from a pharmacist obtain their results?

ColonCancerCheck assumes that any participant who received an FOBT from a pharmacist does not have a health care provider.

Participants with normal (negative) test results, and participants who submitted kits that the laboratory was unable to obtain a result from (result was inconclusive or the kit was unable to be processed), will receive a letter from ColonCancerCheck informing them of their test result.

Participants with abnormal (positive) test results will be contacted by ColonCancerCheck to discuss follow-up care.

Participants who have not heard from the ColonCancerCheck program about their results within a month of completing the test should call 1-866-662-9233.

12. Is the pharmacist who dispensed the FOBT kit responsible for follow-up care if a participant has an abnormal (positive) FOBT result?

No, the pharmacist who dispensed the FOBT kit is not responsible for coordinating follow-up care if a participant has an abnormal (positive) FOBT result. ColonCancerCheck will contact the participant to discuss follow-up care.

13. What does an abnormal (positive) FOBT test result mean?

An abnormal FOBT result means that blood was found in the stool. The pharmacist should reassure the participant that an abnormal FOBT does not mean that they have cancer but it is very important that they receive follow-up testing. Research shows that 1 in 20 individuals with an abnormal FOBT will be diagnosed with colorectal cancer after undergoing a follow-up colonoscopy.

14. What if the participant’s first test is inconclusive (a result could not be obtained) or it was rejected for processing and the participant is requesting another kit?

There are a number of reasons why a test may be inconclusive or rejected for processing.

They include :

Reasons for an inconclusive result include :

If the test is inconclusive or rejected, the participant will receive a letter from ColonCancerCheck informing them that the test was not processed or that the test was inconclusive (neither positive nor negative). The participant will be directed to get a new FOBT kit, either from their health care provider if they now have one, or from a pharmacy or Telehealth Ontario if they do not currently have a health care provider.

Pharmacists should re-assess whether the participant meets the eligibility criteria before providing another FOBT kit and ensure that they understand how to do the test correctly to avoid similar problems.

15. What if a participant presents at the pharmacy asking about their results?

Pharmacists will not have access to a participant’s test results. Participants will receive notification of their result through a letter from ColonCancerCheck. If a participant has not received their result after a month, they should be directed to contact ColonCancerCheck at 1-866-662-9233.

 

Processes And Remuneration

16. How can pharmacists obtain FOBT kits?

For participants with a negative FOBT, the ColonCancerCheck program will send them a letter informing them of their results. They will also be reminded by the program to take the test again in another two years.

For participants with a positive FOBT, the ColonCancerCheck program will arrange an appointment with a family physician to facilitate follow-up care which may include a referral for colonoscopy. A positive FOBT does not mean that the participant has cancer, as 10% of participants with a positive result in one window will have cancer.

If a participant has not heard from the ColonCancerCheck program about their results within a month of completing the test, the participant should call 1-866-662-9233.

17. Where can pharmacists get a laboratory requisition form fors FOBT?

Pharmacists can obtain a laboratory requisition form from ColonCancerCheck Forms can be photocopied as required.

Alternatively, the forms can be downloaded from ontario.ca under the "Forms" repository.  After choosing a language (English/French), click the “Forms” item, which is found under the "Resources" banner. Type the form number 4533-84 into the "Quick Search" window to find the form.

18. What is the PIN (Product Identification Number) for the FOBT kit?

The PIN for the FOBT is 93899960.

19. Where can pharmacists order more patient education materials?

Patient education materials can be downloaded and printed from ColonCancerCheck, including the FOBT instruction sheet in English, French and 26 other languages. Materials in hardcopy can be ordered from Service Ontario at :

20. What fees can pharmacists claim for colorectal cancer screening?

Distributing an FOBT kit is a paid service for community pharmacists at a rate of $ 7.00.

21. How does a pharmacist submit an FOBT claim?

After the pharmacist has reviewed the requisition form for eligibility and completeness, an online FOBT claim can be submitted to the Ontario Drug Benefit (ODB) Health Network System (HNS). Software system changes are required.

An FOBT claim for distributing the FOBT kit must be submitted to the ODB HNS with the following information:

Participant Gender “F” = female, “M” =male
Participant Date of Birth YYYYMMDD
Participant Health Card # As noted on Health Card
Product Identification Number (PIN) “93899960” = FOBT PIN for kit distribution
Intervention Code “PS” = Professional Care Service
“ML” = Eligibility established- Standard coverage
Carrier ID “G” = ColonCancerCheck Plan Code
Pharmacist’s ID code Pharmacist OCP License #
Colorectal Screening Fee – FOBT Distribution $ 7.00

 

22. What should pharmacists do with the FOBT requisition form?

After submitting the online FOBT claim, pharmacists are asked to affix the prescription label on the FOBT requisition form and ensure completeness of the form prior to signing it. The prescription label provides details to the participating laboratory in case the information on the FOBT requisition form is unclear. You may be contacted by the participating laboratory staff to clarify details on the FOBT form or if the form is not completely filled out. ColonCancerCheck will use the information on the FOBT requisition form to send letters to participants informing them of their test result or to follow-up with participants who have positive test results.

Note: The Pharmacy ID, as requested on the FOBT requisition form, is the unique identification number assigned to your pharmacy. It is the ten digit Canadian Pharmacists’ Association (CPhA) number for accredited community pharmacies that begins with “ON”.

The FOBT kit must be provided to the individual together with the completed and signed requisition form. While not required, the pharmacy may retain a copy of the completed laboratory requisition form. Once the FOBT test is completed at home, the kit together with the requisition form may be dropped off at a participating laboratory or mailed to the laboratory in the pre-paid self-addressed envelope provided. Completed FOBT kits should NOT be returned to the pharmacy.

23. What is inside the ColonCancerCheck FOBT kit?

The ColonCancerCheck FOBT kit includes easy-to-read instructions, a test card, specimen collection sticks, privacy statement, a leak-proof envelope to protect the test card, and a pre-paid self-addressed return envelope.

24. How often can colorectal cancer screening services be provided to the same individual?

Individuals aged 50 to 74 years at average risk of colorectal cancer should be screened with FOBT once every two years.

In the case where the individual has lost or damaged their FOBT kit, pharmacists can provide another kit and a new requisition form will need to be completed if the previous one is no longer available (e.g. lost or damaged).

The Colorectal Screening Fee - FOBT Distribution is limited to a maximum of one claim submission per patient once every two (2) year period.

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Further Information

25. Where can pharmacists go if they have additional questions about the ColonCancerCheck program?

Pharmacists can obtain more information about the ColonCancerCheck program by:

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1 Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2011. Toronto, ON: Canadian Cancer Society; 2011

For More Information

For more information about ColonCancerCheck, call ServiceOntario INFOline at 1-866-410-5853.
Hours of operation : 8:30am - 5:00pm, Monday to Friday.
TTY 1-800-387-5559.
Email : ColonCancerCheck.moh@ontario.ca or
Visit : Cancer Care Ontario