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.
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 cancerpatients 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 cancerpatients. 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.
Authors: Steven T Fleming; Susan A Sabatino; Gretchen Kimmick; Rosemary Cress; Xiao-Cheng Wu; Amy Trentham-Dietz; Bin Huang; Wenke Hwang; Jonathan Liff Journal: Med Care Date: 2011-08 Impact factor: 2.983
Authors: Jennifer S Haas; Phyllis Brawarsky; Aarthi Iyer; Garrett M Fitzmaurice; Bridget A Neville; Craig Earle Journal: Cancer Date: 2011-03-16 Impact factor: 6.860
Authors: Eugene J Lengerich; Thomas C Tucker; Raymond K Powell; Pat Colsher; Erik Lehman; Ann J Ward; Jennifer C Siedlecki; Stephen W Wyatt Journal: J Rural Health Date: 2005 Impact factor: 4.333
Authors: Lori R Armstrong; Trevor Thompson; H Irene Hall; Steven S Coughlin; Brooke Steele; Joe D Rogers Journal: Cancer Date: 2004-12-15 Impact factor: 6.860
Authors: Rosemary D Cress; Alan M Zaslavsky; Dee W West; Robert E Wolf; Martha C Felter; John Z Ayanian Journal: Med Care Date: 2003-09 Impact factor: 2.983
Authors: Dorothy Romanus; Martin R Weiser; John M Skibber; Anna Ter Veer; Joyce C Niland; John L Wilson; Ashwani Rajput; Yu-Ning Wong; Al B Benson; Stephen Shibata; Deborah Schrag Journal: J Natl Compr Canc Netw Date: 2009-09 Impact factor: 11.908
Authors: Pamela Farley Short; John R Moran; Tse-Chuan Yang; Fabian Camacho; Niraj J Gusani; Heath B Mackley; Stephen A Matthews; Roger T Anderson Journal: Med Care Res Rev Date: 2015-11-27 Impact factor: 3.929
Authors: Gretchen G Kimmick; Fabian Camacho; Heath B Mackley; Teresa Kern; Nengliang Yao; Stephen A Matthews; Steven Fleming; Joseph Lipscomb; Jason Liao; Wenke Hwang; Roger T Anderson Journal: J Oncol Pract Date: 2014-09-16 Impact factor: 3.840
Authors: Arica White; Djenaba Joseph; Sun Hee Rim; Christopher J Johnson; Michel P Coleman; Claudia Allemani Journal: Cancer Date: 2017-12-15 Impact factor: 6.860
Authors: Zeta Chow; Tong Gan; Quan Chen; Bin Huang; Nancy Schoenberg; Mark Dignan; B Mark Evers; Avinash S Bhakta Journal: J Am Coll Surg Date: 2020-02-13 Impact factor: 6.532