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HSR&D 2004 National Meeting Abstracts

1008. Colorectal Cancer-Risk Factors for Advanced Disease
Dawn Provenzale, MD, MS, Durham VAMC, C Martin, UNC-Chapel Hill, J Galanko, UNC-Chapel Hill, RS Sandler, UNC-Chapel Hill, MD Noble, Duke University, D Provenzale, Durham VAMC

Objectives: Colorectal cancer (CRC) is curable if diagnosed early, but survival is poor at advanced stages. Our aim was to identify prognostic factors of late stage CRC in a population of veterans.

Methods: Telephone interview of consecutive patients aged 40 to 85 with a first diagnosis of proven CRC between July 1, 1997 and January 1, 2001, at 15 sites. Information about lifestyle, education, poverty, health care access and utilization were obtained. Cancer data were abstracted from tumor registries and medical records. The primary outcome was stage at presentation: early (Dukes stage A or B) versus late (Dukes stage C or metastatic). We used simple contingency table methods to examine the relationship between potential risk factors for early versus advanced stage disease, and logistic regression to simultaneously control for potential confounding factors.

Results: Approximately 43% presented with late stage CRC (n=549). In univariate analysis, lacking a usual source of healthcare, lack of participation in any CRC screening test in the last 10 years, presence of blood in stool, and unexplained weight loss were associated with late stage CRC. With logistic regression, only lacking a usual source of healthcare and unexplained weight loss were associated with late stage CRC (odds ratio, 95% confidence intervals) (2.5, 1.7-5.0) and 1.9 (1.2-3.0).

Conclusions: Over 40% of veterans presented with late stage CRC. The only independent predictor of late stage disease was lacking a usual source of healthcare.

Impact: Improving access to primary care may reduce presentation with late stage and mortality from colorectal cancer.