Adjuvant chemotherapy among medicaid-enrolled patients diagnosed with nonmetastatic colon cancer.

OBJECTIVE: It has been suggested that low-income populations may not receive adjuvant chemotherapy for colon cancer, although factors associated with its receipt have not been well-elucidated. This article describes the characteristics associated with chemotherapy among a Medicaid-insured population diagnosed with colon cancer.
METHODS: A retrospective cohort design among 692 Medicaid-insured individuals diagnosed with regional colon cancer was conducted. Logistic regression analyses assessed patient, hospital, and community characteristics associated with chemotherapy. Data were derived from the N.C. Central Cancer Registry, N.C. Medicaid Claims, the American Hospital Directory, and the US Census.
RESULTS: Forty-two percent received chemotherapy. Persons <65 years of age, diagnosis and treatment at different facilities, and living in a community with a higher percentage of persons in poverty were associated with receipt of chemotherapy. Individuals <65 years at time of diagnosis and had a score of 1+ on the Charlson Comorbidity index were 16% less likely to receive chemotherapy as those less than 65 years of age with no comorbid conditions. Receipt of chemotherapy among those 65 to 74 and those 75 and older did not differ appreciably by comorbidity status.
CONCLUSION: Patient age was important in predicting who received adjuvant care, although the impact of comorbidity on chemotherapy was more pronounced among those <65 years of age.