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Clinical, Sociodemographic, and Service Provider Determinants of Guideline Concordant Colorectal Cancer Care for Appalachian Residents

Authors

  • Steven T. Fleming PhD,

    Corresponding author
    1. Departments of Epidemiology & Health Services Management, University of Kentucky College of Public Health, Lexington, Kentucky
    • For further information, contact: Steven Fleming, PhD, Department of Epidemiology, University of Kentucky, 111 Washington Ave., Lexington, KY 40536; e-mail: stflem2@uky.edu.

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  • Heath B. Mackley MD,

    1. Division of Radiation Oncology, Penn State Hershey Cancer Institute, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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  • Fabian Camacho MS,

    1. Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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  • Eric E. Seiber PhD,

    1. Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, Ohio
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  • Niraj J. Gusani MD, MS,

    1. Section of Surgical Oncology, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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  • Stephen A. Matthews PhD,

    1. Departments of Sociology and Anthropology, The Pennsylvania State University, University Park, Pennsylvania
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  • Jason Liao PhD,

    1. Biostatistics Core, Penn State Hershey Cancer Institute, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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  • Tse-Chuan Yang PhD,

    1. Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania
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  • Wenke Hwang PhD,

    1. Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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  • Nengliang Yao PhD

    1. Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania
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  • Funding: The Patterns of Patient Care in Appalachia Study was supported by the National Cancer Institute (1R01CA140335). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Cancer Institute. Additional support has been provided by the Population Research Institute which receives core funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Award R24-HD41025. None of the authors have any financial disclosures to report.

Abstract

Background

Colorectal cancer represents a significant cause of morbidity and mortality, particularly in Appalachia where high mortality from colorectal cancer is more prevalent. Adherence to treatment guidelines leads to improved survival. This paper examines determinants of guideline concordance for colorectal cancer.

Methods

Colorectal cancer patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Carolina) were linked to Medicare claims (2005-2009). Final sample size after exclusions was 2,932 stage I-III colon, and 184 stage III rectal cancer patients. The 3 measures of guideline concordance include adjuvant chemotherapy (stage III colon cancer, <80 years), ≥12 lymph nodes assessed (resected stage I-III colon cancer), and radiation therapy (stage III rectal cancer, <80 years). Bivariate and multivariate analyses with clinical, sociodemographic, and service provider covariates were estimated for each of the measures.

Results

Rates of chemotherapy, lymph node assessment, and radiation were 62.9%, 66.3%, and 56.0%, respectively. Older patients had lower rates of chemotherapy and radiation. Five comorbidities were significantly associated with lower concordance in the bivariate analyses: myocardial infarction, congestive heart failure, respiratory diseases, dementia with chemotherapy, and diabetes with adequate lymph node assessment. Patients treated by hospitals with no Commission on Cancer (COC) designation or lower surgical volumes had lower odds of adequate lymph node assessment.

Conclusions

Clinical, sociodemographic, and service provider characteristics are significant determinants of the variation in guideline concordance rates of 3 colorectal cancer measures.

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