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Health Services Research & Development

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2009 HSR&D National Meeting Abstract

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National Meeting 2009

1070 — Examining Disparities in Colon Cancer Treatment: Length of Time to Chemotherapy Initiation

Tarlov E (VIReC), Durazo R (Center for Management of Complex Chronic Care), Weichle T (Center for Management of Complex Chronic Care), Zhang Q (Center for Management of Complex Chronic Care), Perrin RA (Center for Management of Complex Chronic Care), Lee TA (Center for Management of Complex Chronic Care), Bennett CL (Center for Management of Complex Chronic Care), Hynes DM (Center for Management of Complex Chronic Care)

Objectives:
Age- and race-based disparities in cancer treatment and survival have been observed for many cancer sites, including colon cancer. Recent research has focused on treatment delay as one potential explanation for survival disparities. The question of treatment parity across age and race groups has received little research attention in the VA cancer population. In this investigation, our objective was to ascertain whether age and race disparities in time from surgery to adjuvant chemotherapy initiation exist in a cohort of elderly veterans with colon cancer.

Methods:
We conducted a retrospective cohort study that used multiple linked databases. We identified a cohort of veterans from eight SEER cancer registries who were diagnosed with colon cancer between 1999 and 2001 at age 66 or older and were eligible for VA and Medicare-funded care. Using descriptive statistics and Cox proportional hazards regression modeling, we examined the relationship between age and race/ethnicity and time to adjuvant chemotherapy initiation.

Results:
Among the 1,053 veterans identified with colon cancer who were potentially eligible for adjuvant chemotherapy (stage II or III and post-colectomy), mean age was 76 years and 14% were African American. Rates of chemotherapy initiation varied across age group (from 53% among patients 66-to-75 years old to 11% among those 86 years and older) and race/ethnicity (31% among African Americans and 41% among non-African Americans). Mean time to chemotherapy initiation was 49 days (range 2–182 days) and did not vary statistically by age or race/ethnicity group. Cox models controlling for stage, comorbidity, geographic region, and hospital type (VA vs non-VA) revealed that increasing age was associated with longer time to chemotherapy initiation (compared to patients age 66-to-75 years, IIR 0.49, CI: 0.40-0.60 among patients age 76-to-85 years and IIR 0.15, CI: 0.07-0.33 among those 86 years or older). African American race/ethnicity was also associated with longer time to chemotherapy initiation (compared to non-African American patients, IIR 0.63, CI: 0.46-0.87).

Implications:
Among veterans with colon cancer, age and African American race/ethnicity were associated with longer time to chemotherapy initiation, even when stage, comorbidity, geography, and VA/non-VA treatment facility were considered.

Impacts:
Delays in treatment may contribute to age- and race-based disparities in colon cancer outcomes. More research is needed to better understand causes and consequences of treatment delays.


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