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Examining disparities in colon cancer treatment patterns
Hynes DM, Tarlov E, Lee TA, Perrin RA, Zhang Q, Ferreira M, Durazo-Arvizu R, Benson AB, Bentrem D, Bennett CL. Examining disparities in colon cancer treatment patterns. [Abstract]. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2008 May 20; 26(15S):6534.
Background: Disparities in colon cancer treatment are a national concern, as they are among veterans in particular. Through agreements with eight National Cancer Institute Surveillance, Epidemiology and End Results (SEER) Program registries, we linked cancer registry, Medicare, and VA data to examine disparities in colon cancer treatment patterns. Methods: We identified a cohort of colon cancer patients from eight SEER registries who were diagnosed between 1999 and 2001 at age 66 or older and were eligible for VA and Medicare-funded care. We tracked care through 2004 and examined surgery and chemotherapy use and trends in one-year mortality. We used regression models to examine the relationship between age and race/ethnicity and adjuvant chemotherapy use. Results: Among the 2,027 veterans identified with colon cancer, 95% were male; 14% were African American; 17% were diagnosed at a VA facility; 1,788 (88%) underwent colectomy; 358 (20%) underwent colectomy at a VA facility. The one-year mortality rate was 28% overall. Among the 1,788 patients who underwent colectomy, prevalence of chemotherapy use was 9%, 27%, 58%, and 48% in stages I to IV, respectively (p-value < 0.0001). Among the 1,074 stage II and III colectomy patients for whom hospital type (VA vs. non-VA) was known, a regression analysis controlling for comorbidity, stage, geographic region, and hospital type revealed that African Americans were less likely than non-African Americans (OR 0.54, CI: 0.34-0.84) and patients age 76-to-85 years and those 86 years or older were less likely than those age 66-to-75 years (OR 0.38, CI: 0.29-0.51 and OR 0.08, CI: 0.03-0.18, respectively) to receive adjuvant chemotherapy. We also found that veterans who underwent colectomy at a non-VA facility were more likely to receive adjuvant chemotherapy (OR 1.78, CI: 1.23-2.58). Conclusions: Among veterans with colon cancer identified in eight SEER registries, older and African American patients were less likely to receive chemotherapy even when stage, comorbidity, and geography were considered. Adherence to adjuvant chemotherapy guidelines among patients treated in VA hospitals warrants additional research. Efforts to better understand and address apparent disparities in colon cancer care are urgently needed.