Abstract

Background: Appalachia has high colorectal cancer (CRC) incidence and mortality, at least in part due to screening disparities. This paper examines patterns and determinants of metastatic colorectal cancer care. Methods: CRC patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Carolina) were linked to Medicare claims (2005-2009.) The final sample after exclusions included 855 stage IV and 590 stages I-III patients with metachronous or synchronous metastases. We estimate bivariate and multivariate analyses for several surgical and chemotherapeutic strategies of care using clinical, sociodemographic, and contextual determinants. Results: Among 1,445 CRC patients, 84% had primary tumor resection and 44% received chemotherapy. Of the chemotherapy patients, 44% received newer systemic agents for at least 75% of the cycles. One year survivors with liver or lung metastases were more likely to have their primary tumor resected immediately (86.1% vs 69.5% for liver, and 78.2% vs 64.9% for lung) and have their metastases resected/ablated (15.7% vs 2.6% for liver and 15.0% vs 0.5% for lung). Patients with stages I-III primary tumors (versus IV) were much more likely to be resected, but they were less likely to receive chemotherapy. Patients with comorbidities (congestive heart failure, dementia, or respiratory disease) had lower odds of chemotherapy. Smaller hospital size and surgical volume had higher odds of immediate versus delayed surgery. The newer chemotherapeutic agents were more common with higher surgical volume. Conclusions: Metastatic colorectal cancer has clinical, sociodemographic, and service provider determinants.

Original languageEnglish (US)
Pages (from-to)113-124
Number of pages12
JournalJournal of Rural Health
Volume32
Issue number2
DOIs
StatePublished - Mar 1 2016

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Appalachian Region
Colorectal Neoplasms
Drug Therapy
Neoplasm Metastasis
Lung
Liver
Neoplasms
Health Facility Size
Medicare
Survivors
Dementia
Registries
Comorbidity
Multivariate Analysis
Heart Failure
Mortality
Incidence

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health

Cite this

@article{16396dd9008f4443a262a6ea55865403,
title = "Patterns of Care for Metastatic Colorectal Cancer in Appalachia, and the Clinical, Sociodemographic, and Service Provider Determinants",
abstract = "Background: Appalachia has high colorectal cancer (CRC) incidence and mortality, at least in part due to screening disparities. This paper examines patterns and determinants of metastatic colorectal cancer care. Methods: CRC patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Carolina) were linked to Medicare claims (2005-2009.) The final sample after exclusions included 855 stage IV and 590 stages I-III patients with metachronous or synchronous metastases. We estimate bivariate and multivariate analyses for several surgical and chemotherapeutic strategies of care using clinical, sociodemographic, and contextual determinants. Results: Among 1,445 CRC patients, 84{\%} had primary tumor resection and 44{\%} received chemotherapy. Of the chemotherapy patients, 44{\%} received newer systemic agents for at least 75{\%} of the cycles. One year survivors with liver or lung metastases were more likely to have their primary tumor resected immediately (86.1{\%} vs 69.5{\%} for liver, and 78.2{\%} vs 64.9{\%} for lung) and have their metastases resected/ablated (15.7{\%} vs 2.6{\%} for liver and 15.0{\%} vs 0.5{\%} for lung). Patients with stages I-III primary tumors (versus IV) were much more likely to be resected, but they were less likely to receive chemotherapy. Patients with comorbidities (congestive heart failure, dementia, or respiratory disease) had lower odds of chemotherapy. Smaller hospital size and surgical volume had higher odds of immediate versus delayed surgery. The newer chemotherapeutic agents were more common with higher surgical volume. Conclusions: Metastatic colorectal cancer has clinical, sociodemographic, and service provider determinants.",
author = "Fleming, {Steven T.} and Mackley, {Heath B.} and Fabian Camacho and Nengliang Yao and Gusani, {Niraj J.} and Seiber, {Eric E.} and Matthews, {Stephen A.} and Yang, {Tse Chuan} and Wenke Hwang",
year = "2016",
month = "3",
day = "1",
doi = "10.1111/jrh.12132",
language = "English (US)",
volume = "32",
pages = "113--124",
journal = "Journal of Rural Health",
issn = "0890-765X",
publisher = "Wiley-Blackwell",
number = "2",

}

Patterns of Care for Metastatic Colorectal Cancer in Appalachia, and the Clinical, Sociodemographic, and Service Provider Determinants. / Fleming, Steven T.; Mackley, Heath B.; Camacho, Fabian; Yao, Nengliang; Gusani, Niraj J.; Seiber, Eric E.; Matthews, Stephen A.; Yang, Tse Chuan; Hwang, Wenke.

In: Journal of Rural Health, Vol. 32, No. 2, 01.03.2016, p. 113-124.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Patterns of Care for Metastatic Colorectal Cancer in Appalachia, and the Clinical, Sociodemographic, and Service Provider Determinants

AU - Fleming, Steven T.

AU - Mackley, Heath B.

AU - Camacho, Fabian

AU - Yao, Nengliang

AU - Gusani, Niraj J.

AU - Seiber, Eric E.

AU - Matthews, Stephen A.

AU - Yang, Tse Chuan

AU - Hwang, Wenke

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Background: Appalachia has high colorectal cancer (CRC) incidence and mortality, at least in part due to screening disparities. This paper examines patterns and determinants of metastatic colorectal cancer care. Methods: CRC patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Carolina) were linked to Medicare claims (2005-2009.) The final sample after exclusions included 855 stage IV and 590 stages I-III patients with metachronous or synchronous metastases. We estimate bivariate and multivariate analyses for several surgical and chemotherapeutic strategies of care using clinical, sociodemographic, and contextual determinants. Results: Among 1,445 CRC patients, 84% had primary tumor resection and 44% received chemotherapy. Of the chemotherapy patients, 44% received newer systemic agents for at least 75% of the cycles. One year survivors with liver or lung metastases were more likely to have their primary tumor resected immediately (86.1% vs 69.5% for liver, and 78.2% vs 64.9% for lung) and have their metastases resected/ablated (15.7% vs 2.6% for liver and 15.0% vs 0.5% for lung). Patients with stages I-III primary tumors (versus IV) were much more likely to be resected, but they were less likely to receive chemotherapy. Patients with comorbidities (congestive heart failure, dementia, or respiratory disease) had lower odds of chemotherapy. Smaller hospital size and surgical volume had higher odds of immediate versus delayed surgery. The newer chemotherapeutic agents were more common with higher surgical volume. Conclusions: Metastatic colorectal cancer has clinical, sociodemographic, and service provider determinants.

AB - Background: Appalachia has high colorectal cancer (CRC) incidence and mortality, at least in part due to screening disparities. This paper examines patterns and determinants of metastatic colorectal cancer care. Methods: CRC patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Carolina) were linked to Medicare claims (2005-2009.) The final sample after exclusions included 855 stage IV and 590 stages I-III patients with metachronous or synchronous metastases. We estimate bivariate and multivariate analyses for several surgical and chemotherapeutic strategies of care using clinical, sociodemographic, and contextual determinants. Results: Among 1,445 CRC patients, 84% had primary tumor resection and 44% received chemotherapy. Of the chemotherapy patients, 44% received newer systemic agents for at least 75% of the cycles. One year survivors with liver or lung metastases were more likely to have their primary tumor resected immediately (86.1% vs 69.5% for liver, and 78.2% vs 64.9% for lung) and have their metastases resected/ablated (15.7% vs 2.6% for liver and 15.0% vs 0.5% for lung). Patients with stages I-III primary tumors (versus IV) were much more likely to be resected, but they were less likely to receive chemotherapy. Patients with comorbidities (congestive heart failure, dementia, or respiratory disease) had lower odds of chemotherapy. Smaller hospital size and surgical volume had higher odds of immediate versus delayed surgery. The newer chemotherapeutic agents were more common with higher surgical volume. Conclusions: Metastatic colorectal cancer has clinical, sociodemographic, and service provider determinants.

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U2 - 10.1111/jrh.12132

DO - 10.1111/jrh.12132

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