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Digestive Diseases and Sciences
Published in: Digestive Diseases and Sciences 12/2009

01-12-2009 | Original Article

Factors Associated with Colon Cancer Stage at Diagnosis

Authors: Michael T. Halpern, Alexandre L. Pavluck, Clifford Y. Ko, Elizabeth M. Ward

Published in: Digestive Diseases and Sciences | Issue 12/2009

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Abstract

We analyzed data from 1998–2004 from the National Cancer Data Base to evaluate associations between patient/treatment facility factors and stage at diagnosis for all colon cancers combined and by anatomic location. Compared to patients with private insurance, uninsured patients were significantly more likely to present with advanced-stage disease; Medicaid patients had likelihoods of advanced-stage colon cancer in-between those of privately insured and uninsured patients. Increased odds of advanced-stage colon cancer at diagnosis were also observed among Black (vs. White) patients, women (vs. men), and patients from low socioeconomic status (SES) regions (vs. those from higher SES regions). While the likelihood of advanced-stage disease at diagnosis decreased in later years overall, this decrease was not observed among patients with ascending colon cancers. Screening disparities may lead to more advanced stage at diagnosis among colon cancer patients; programs to improve access to screening among underserved populations may address this disparity.
Literature
1.
American Cancer Society. Cancer Facts and Figs 2008. Atlanta: American Cancer Society; 2008.
2.
Ayanian JZ, Weissman JS, Schneider EC, Ginsburg JA, Zaslavsky AM. Unmet health needs of uninsured adults in the United States. JAMA. 2000;284:2061–2069.CrossRefPubMed
3.
Chen JY, Diamant A, Pourat N, Kagawa-Singer M. Racial/ethnic disparities in the use of preventive services among the elderly. Am J Prev Med. 2005;29:388–395.CrossRefPubMed
4.
Gordon NP, Rundall TG, Parker L. Type of health care coverage and the likelihood of being screened for cancer. Med Care. 1998;36:636–645.CrossRefPubMed
5.
Hsia J, Kemper E, Kiefe C, et al. The importance of health insurance as a determinant of cancer screening: evidence from the Women’s Health Initiative. Prev Med. 2000;31:261–270.CrossRefPubMed
6.
Ioannou GN, Chapko MK, Dominitz JA. Predictors of colorectal cancer screening participation in the United States. Am J Gastroenterol. 2003;98:2082–2091.CrossRefPubMed
7.
Kandula NR, Wen M, Jacobs EA, Lauderdal DS. Low rates of colorectal, cervical, and breast cancer screening in Asian Americans compared with non-Hispanic Whites: cultural influences or access to care? Cancer. 2006;107:184–192.CrossRefPubMed
8.
Ko CW, Kreuter W, Baldwin LM. Effect of Medicare coverage on use of invasive colorectal cancer screening tests. Arch Intern Med. 2002;162:2581–2586.CrossRefPubMed
9.
Pollack LA, Blackman DK, Wilson KM, Seeff LC, Nadel MR. Colorectal cancer test use among Hispanic and non-Hispanic US populations. Prev Chronic Dis. 2006;3:A50.PubMed
10.
Potosky AL, Breen N, Graubard BI, Parsons PE. The association between health care coverage, the use of cancer screening tests. Results from the National Health Interview Survey. Med Care. 1998;36:257–270.CrossRefPubMed
11.
Ross JS, Bradley EH, Busch SH. Use of health care services by lower-income and higher-income uninsured adults. JAMA. 2006;295:2027–2036.CrossRefPubMed
12.
Seeff LC, Nadel MR, Klabunde CN, et al. Patterns and predictors of colorectal cancer test use in the adult US population. Cancer. 2004;100:2093–2103.CrossRefPubMed
13.
Ward E, Halpern M, Schrag N, et al. Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin. 2008;58:9–31.CrossRefPubMed
14.
Gross CP, Andersen MS, Krumholz HM, McAvay GJ, Proctor D, Tinetti ME. Relation between Medicare screening reimbursement and stage at diagnosis for older patients with colon cancer. JAMA. 2006;296:2815–2822.CrossRefPubMed
15.
Bradley CJ, Given CW, Roberts C. Disparities in cancer diagnosis and survival. Cancer. 2001;91:178–188.CrossRefPubMed
16.
Campbell RJ, Ferrante JM, Gonzalez EC, Roetzheim RG, Pal N, Herold A. Predictors of advanced-stage colorectal cancer diagnosis: results of a population-based study. Cancer Detect Prev. 2001;25:430–438.PubMed
17.
Fazio L, Cotterchio M, Manno M, McLaughlin J, Gallinger S. Association between colonic screening, subject characteristics, and stage of colorectal cancer. Am J Gastroenterol. 2005;100:2531–2539.CrossRefPubMed
18.
Frederiksen BL, Osler M, Harling H, Danish Colorectal Cancer Group, Jørgensen T. Social inequalities in stage at diagnosis of rectal but not in colonic cancer: a nationwide study. Br J Cancer. 2008;98:668–673.CrossRefPubMed
19.
Gonzalez EC, Ferrante JM, Van Durme DJ, Pal N, Roetzheim RG. Comorbid illness and the early detection of cancer. South Med J. 2001;94:913–920.PubMed
20.
Lee-Feldstein A, Feldstein PJ, Buchmueller T. Health care factors related to stage at diagnosis and survival among Medicare patients with colorectal cancer. Med Care. 2002;40:362–374.CrossRefPubMed
21.
Longnecker MP, Clapp RW, Sheahan K. Associations between smoking status and stage of colorectal cancer at diagnosis in Massachusetts between 1982 and 1987. Cancer. 1989;64:1372–1374.CrossRefPubMed
22.
Mandelblatt J, Andrews H, Kao R, Wallace R, Kerner J. The late-stage diagnosis of colorectal cancer: demographic and socioeconomic factors. Am J Public Health. 1996;86:1794–1797.CrossRefPubMed
23.
Parikh-Patel A, Bates JH, Campleman S. Colorectal cancer stage at diagnosis by socioeconomic and urban/rural status in California, 1988–2000. Cancer. 2006;107:1189–1195.CrossRefPubMed
24.
Parsons MA, Askland KD. Cancer of the colorectum in Maine, 1995–1998: determinants of stage at diagnosis in a rural state. J Rural Health. 2007;23:25–32.CrossRefPubMed
25.
Pollack LA, Gotway CA, Bates JH, et al. Use of the spatial scan statistic to identify geographic variations in late stage colorectal cancer in California (United States). Cancer Causes Control. 2006;17:449–457.CrossRefPubMed
26.
Roetzheim RG, Pal N, Tennant C, et al. Effects of health insurance and race on early detection of cancer. J Natl Cancer Inst. 1999;91:1409–1415.CrossRefPubMed
27.
Rogers SO, Ray WA, Smalley WE. A population-based study of survival among elderly persons diagnosed with colorectal cancer: does race matter if all are insured? (United States). Cancer Causes Control. 2004;15:193–199.CrossRefPubMed
28.
Schwartz KL, Crossley-May H, Vigneau FD, Brown K, Banerjee M. Race, socioeconomic status and stage at diagnosis for five common malignancies. Cancer Causes Control. 2003;14:761–766.CrossRefPubMed
29.
Woods SE, Basho S, Engel A. The influence of gender on colorectal cancer stage: the state of Ohio, 1996–2001. J Womens Health (Larchmt). 2006;15:877–881.CrossRef
30.
Halpern MT, Ward EM, Pavluck AL, Schrag NM, Bian J, Chen AY. Association of insurance status and race/ethnicity with cancer stage at diagnosis: a retrospective analysis. Lancet Oncol. 2008;9:222–231.CrossRefPubMed
31.
32.
33.
34.
Greene F, Page D, Fleming I, et al. AJCC cancer staging manual. 6th ed. Chicago, IL: Springer; 2002.
35.
Fritz A, Percy C, Jack A, et al. International Classification of Diseases for Oncology, ICD-O. 3rd ed. Geneva: World Health Organization; 2000.
36.
Breslow NE, Day NE. Statistical Methods in Cancer Research. Vol 1. The Analysis of Case-Control Studies. Lyons: International Agency for Research on Cancer; 1980.
37.
Shavers VL. Racial/ethnic variation in the anatomic subsite location of in situ and invasive cancers of the colon. J Natl Med Assoc. 2007;99:733–748.PubMed
38.
Thornton JG, Morris AM, Thornton JD, Flowers CR, McCashland TM. Racial variation in colorectal polyp and tumor location. J Natl Med Assoc. 2007;99:723–728.PubMed
39.
Ko CW, Kreuter W, Baldwin LM. Persistent demographic differences in colorectal cancer screening utilization despite Medicare reimbursement. BMC Gastroenterol. 2005;5:10.CrossRefPubMed
40.
Gerharz CD, Gabbert H, Krummel F. Age-dependent shift-to-the-right in the localization of colorectal adenomas. Virchows Arch A Pathol Anat Histopathol. 1987;411:591–598.CrossRefPubMed
41.
Thörn M, Bergström R, Kressner U, Sparén P, Zack M, Ekbom A. Trends in colorectal cancer incidence in Sweden 1959–1993 by gender, localization, time period, and birth cohort. Cancer Causes Control. 1998;9:145–152.CrossRefPubMed
42.
Cress RD, Morris C, Ellison GL, Goodman MT. Secular changes in colorectal cancer incidence by subsite, stage at diagnosis, and race/ethnicity, 1992–2001. Cancer. 2006;107:1142–1152.CrossRefPubMed
43.
Bailey JE, Womeodu RJ, Wan JY, Van Brunt DL, Somes GW. Improvements in diabetes management and outcomes in a Medicaid managed care system. Tenn Med. 2001;94:425–430.PubMed
44.
Fairbrother G, Hanson KL, Butts GC, Friedman S. Comparison of preventive care in Medicaid managed care and Medicaid fee for service in institutions and private practices. Ambul Pediatr. 2001;1:294–301.CrossRefPubMed
45.
Kenney G, Sommers AS, Dubay L. Moving to mandatory Medicaid managed care in Ohio: impacts on pregnant women and infants. Med Care. 2005;43:683–690.CrossRefPubMed
46.
Reisinger AL, Sisk JE. Preventive service use and Medicaid managed care in New York City. Am J Manag Care. 2000;6:45–51.PubMed
47.
Schneider EC, Rosenthal M, Gatsonis CG, Zheng J, Epstein AM. Is the type of Medicare insurance associated with colorectal cancer screening prevalence and selection of screening strategy? Med Care. 2008;46:S84–S90.CrossRefPubMed
48.
Varghese RK, Friedman C, Ahmed FAL, Manning M, Seeff LC. Does health insurance coverage of office visits influence colorectal cancer testing? Cancer Epidemiol Biomarkers Prev. 2005;14:744–747.CrossRefPubMed
49.
Koroukian SM, Litaker D, Dor A, Cooper GS. Use of preventive services by Medicare fee-for-service beneficiaries: does spillover from managed care matter? Med Care. 2005;43:445–452.CrossRefPubMed
50.
Katz SJ, Hofer TP, Hawley S, et al. Patterns and correlates of patient referral to surgeons for treatment of breast cancer. J Clin Oncol. 2007;25:271–276.CrossRefPubMed
51.
Bradley CJ, Given CW, Roberts C. Late stage cancers in a Medicaid-insured population. Med Care. 2003;41:722–728.CrossRefPubMed
52.
Ramsey SD, Zeliadt SB, Richardson LC, et al. Disenrollment from Medicaid after recent cancer diagnosis. Med Care. 2008;46:49–57.CrossRefPubMed
53.
Breen N, Wagener DK, Brown ML, Davis WW, Ballard-Barbash R. Progress in cancer screening over a decade: results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. J Natl Cancer Inst. 2001;93:1704–1713.CrossRefPubMed
54.
Liang SY, Phillips KA, Nagamine M, Ladabaum U, Haas JS. Rates and predictors of colorectal cancer screening. Prev Chronic Dis. 2006;3:A117.PubMed
55.
Phillips KA, Liang SY, Ladabaum U, et al. Trends in colonoscopy for colorectal cancer screening. Med Care. 2007;45:160–167.CrossRefPubMed
56.
Collins JF, Lieberman DA, Durbin TE, Weiss DG, Veterans Affairs Cooperative Study #380 Group. Accuracy of screening for fecal occult blood on a single stool sample obtained by digital rectal examination: a comparison with recommended sampling practice. Ann Intern Med. 2005;142:81–85.PubMed
57.
Morikawa T, Kato J, Yamaji Y, Wada R, Mitsushima T, Shiratori Y. A comparison of the immunochemical fecal occult blood test and total colonoscopy in the asymptomatic population. Gastroenterology. 2005;129:422–428.PubMed
58.
Segnan N, Senore C, Andreoni B, et al. Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening. Gastroenterology. 2007;132:2304–2312.CrossRefPubMed
Metadata
Title
Factors Associated with Colon Cancer Stage at Diagnosis
Authors
Michael T. Halpern
Alexandre L. Pavluck
Clifford Y. Ko
Elizabeth M. Ward
Publication date
01-12-2009
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 12/2009
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-008-0669-0

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