Top

BMC Health Services Research

Published in:

Open Access 01-12-2016 | Research article

Factors associated with late stage at diagnosis among Puerto Rico’s government health plan colorectal cancer patients: a cross-sectional study

Authors: Karen J. Ortiz-Ortiz, Ruth Ríos-Motta, Heriberto Marín-Centeno, Marcia Cruz-Correa, Ana Patricia Ortiz

Published in: BMC Health Services Research | Issue 1/2016

Abstract

Background

Late stage at diagnosis of cancer is considered a key predictor factor for a lower survival rate. Knowing and understanding the barriers to an early diagnosis of colorectal cancer is critical in the fight to reduce the social and economic burden caused by cancer in Puerto Rico. This study evaluates factors associated to colorectal cancer stage at diagnosis among Puerto Rico’s Government Health Plan (GHP) patients.

Methods

We conducted a cross-sectional study based on a secondary data analysis using information from the Puerto Rico Central Cancer Registry (PRCCR) and the Puerto Rico Health Insurance Administration (PRHIA). Logistic regression models were used to estimate the unadjusted odds ratio (ORs) and adjusted odds ratio (AORs), and their 95 % confidence intervals (CIs). Colorectal cancer cases diagnosed between January 1, 2012 and December 31, 2012, among persons 50 to 64 years of age, participants of the GHP and with a cancer diagnosis reported to the PRCCR were included in the study.

Results

There were 68 (35.79 %) colorectal cancer patients diagnosed at early stage while 122 (64.21 %) where diagnosed at late stage. In the multivariate analysis having a diagnostic delay of more than 59 days (AOR 2.94, 95 % CI: 1.32 to 6.52) and having the first visit through the emergency room (AOR 3.48, 95 % CI: 1.60 to 7.60) were strong predictors of being diagnosed with colorectal cancer at a late stage.

Conclusions

These results are relevant to understand the factors that influence the outcomes of colorectal cancer patients in the GHP. Therefore, it is important to continue developing studies to understand the Government Health Plan patient’s pathways to a cancer diagnosis, in order to promote assertive decisions to improve patient outcomes.

Pruitt SL, Harzke AJ, Davidson NO, Schootman M. Do diagnostic and treatment delays for colorectal cancer increase risk of death? Cancer Causes Control [Internet]. 2013;24:961–77. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3708300&tool=pmcentrez&rendertype=abstract.CrossRef

Ortiz-Ortiz KJ, Ramírez-García R, Cruz-Correa M, Ríos-González MY, Ortiz AP. Effects of type of health insurance coverage on colorectal cancer survival in Puerto Rico: a population-based study. Goel A, editor. PLoS One [Internet] Public Libr Sci. 2014;9:e96746. Available from: http://dx.plos.org/10.1371/journal.pone.0096746.CrossRef

Tortolero-Luna G, Zavala-Zegarra D, Pérez-Ríos N, Torres-Cintrón C, Ortiz-Ortiz K, Traverso-Ortiz M, et al. Cancer in Puerto Rico, 2006–2010. San Juan: Puerto Rico Central Cancer Registry; 2013.

Elliott MN, Haviland AM, Dembosky JW, Hambarsoomian K, Weech-Maldonado R. Are there differences in the Medicare experiences of beneficiaries in Puerto Rico compared with those in the U.S. mainland? Med Care [Internet]. 2012;50:243–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22329996.CrossRef

United States Census Bureau. Types of Health Insurance Coverage by Age [Internet]. 2012 Am Community Surv. 1-Year Estim. 2012. Available from: http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_12_1YR_B27010&prodType=table. [cited 2016 Jun 9].

Commonwealth of Puerto Rico. Ley 72. Salud y Sanidad Parte IX. Seguros de Salud 24 L.P.R.A.§7001. Aprobada el 7 de Septiembre de 1993. 1993.

Mulligan J. Unmanageable Care: An Ethnography of Health Care Privatization in Puerto Rico. New York: NYU Press; 2014.CrossRef

Hulme PA, Rios H. Healthcare reform in Puerto Rico. Managed care in a unique environment. J Nurs Adm [Internet]. 1998;28:44–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9484319.CrossRef

Chirikos TN, López-Garcia J, Cintrón Vargas C, Gonzalez OL, Pérez-Grau MP, Baez-Diaz L. Evaluation of breast cancer care under Puerto Rico’s Health Care Reform. J Health Care Poor Underserved [Internet]. 2007;18:116–38. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17337802.CrossRef

10.

Ortiz-Ortiz KJ, Pérez-Irizarry J, Marín-Centeno H, Ortiz AP, Torres-Berrios N, Torres-Cintrón M, et al. Productivity loss in Puerto Rico’s labor market due to cancer mortality. P R Health Sci J. 2010;29:241–9.PubMed

11.

Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention; 2012.

12.

López-Charneco M, Pérez CM, Soto-Salgado M, Rodríguez L, González D, Serrano R, et al. Correlates of colorectal cancer screening among Hispanics: Results from the 2008 Puerto Rico behavioral risk factor surveillance system survey. P R Health Sci J [Internet]. 2013;32:68–75. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4125413&tool=pmcentrez&rendertype=abstract.

13.

Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data [Internet]. U.S.: Department of Health and Human Services, Cen; 2012. Available from: http://www.cdc.gov/brfss.

14.

Phillips KA, Morrison KR, Andersen R, Aday LA. Understanding the context of healthcare utilization: assessing environmental and provider-related variables in the behavioral model of utilization. Health Serv Res Health Res Educ Trust. 1998;33:571.

15.

Mandelblatt J, Yabroff KR, Kerner J. Access to quality cancer care: evaluating and ensuring equitable services, quality of life and survival. Washingt. DC Natl: Cancer Policy Board; 1998.

16.

Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav [Internet]. 1995;36:1–10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7738325.CrossRef

17.

Mandelblatt JS, Yabroff KR, Kerner JF. Equitable access to cancer services. Cancer Wiley Online Library. 1999;86:2378–90.

18.

Spinks T, Albright HW, Feeley TW, Walters R, Burke TW, Aloia T, et al. Ensuring quality cancer care: A follow-up review of the Institute of Medicine’s 10 recommendations for improving the quality of cancer care in America. In: Cancer. 2012. p. 2571–82.

19.

Dwivedi AK. An epidemiological study on delay in treatment initiation of cancer patients. Health (Irvine Calif) [Internet] Scientific Research Publishing. 2012;04:66–79. Available from: http://www.scirp.org/journal/PaperInformation.aspx?PaperID=17482&#abstract.

20.

Dang-Tan T, Trottier H, Mery LS, Morrison HI, Barr RD, Greenberg ML, et al. Delays in diagnosis and treatment among children and adolescents with cancer in Canada. Pediatr. Blood Cancer [Internet] Wiley Subscription Services, Inc, A Wiley Company. 2008;51:468–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18454472.

21.

Butler J, Foot C, Bomb M, Hiom S, Coleman M, Bryant H, et al. The International Cancer Benchmarking Partnership: an international collaboration to inform cancer policy in Australia, Canada, Denmark, Norway, Sweden and the United Kingdom. Health Policy [Internet]. Health Policy [Internet] Elsevier. 2013;112:148–55. Available from: http://www.healthpolicyjrnl.com/article/S0168851013000973/fulltext.CrossRef

22.

Hansen RP, Olesen F, Sørensen HT, Sokolowski I, Søndergaard J. Socioeconomic patient characteristics predict delay in cancer diagnosis: a Danish cohort study. BMC Health Serv Res [Internet]. 2008;8:49. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2311301&tool=pmcentrez&rendertype=abstract.CrossRef

23.

National Patient Safety Agency. Delayed diagnosis of cancer: Thematic review [Internet]. London; 2010. Available from: http://www.nrls.npsa.nhs.uk/resources/?EntryId45=69894. [cited 2015 Apr 7].

24.

Amri R, Bordeianou LG, Sylla P, Berger DL. Treatment delay in surgically-treated colon cancer: does it affect outcomes? Ann Surg Oncol [Internet]. 2014;21:3909–16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24849522.CrossRef

25.

Law CW, Roslani AC, Ng LLC. Treatment delay in rectal cancer. Med J Malaysia [Internet]. 2009;64:163–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20058579.

26.

Gorin SS, Heck JE, Cheng B, Smith SJ. Delays in breast cancer diagnosis and treatment by racial/ethnic group. Arch Intern Med [Internet]. 2006;166:2244–52. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17101943.CrossRef

27.

McPhail S, Elliss-Brookes L, Shelton J, Ives A, Greenslade M, Vernon S, et al. Emergency presentation of cancer and short-term mortality. Br J Cancer [Internet]. 2013;109:2027–34. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3798965&tool=pmcentrez&rendertype=abstract.CrossRef

28.

Arndt V, Stürmer T, Stegmaier C, Ziegler H, Dhom G, Brenner H. Patient delay and stage of diagnosis among breast cancer patients in Germany—a population based study. Br J Cancer [Internet]. 2002;86:1034–40. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2364177&tool=pmcentrez&rendertype=abstract.CrossRef

29.

Hansen RP, Vedsted P, Sokolowski I, Søndergaard J, Olesen F. Time intervals from first symptom to treatment of cancer: a cohort study of 2,212 newly diagnosed cancer patients. BMC Health Serv Res [Internet]. 2011;11:284. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3217887&tool=pmcentrez&rendertype=abstract.CrossRef

30.

Whitlock EP, Lin JS, Liles E, Beil TL, Fu R. Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force. Ann Intern Med [Internet]. 2008;149:638–58. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18838718.CrossRef

31.

D’Hoore W, Bouckaert A, Tilquin C. Practical considerations on the use of the charlson comorbidity index with administrative data bases. J Clin Epidemiol [Internet]. 1996;49:1429–33. Available from: http://www.sciencedirect.com/science/article/pii/S0895435696002715.CrossRef

32.

Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J-C, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care [Internet]. 2005;43:1130–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16224307.CrossRef

33.

Stagg V. CHARLSON: Stata module to calculate Charlson index of comorbidity [Internet]. Boston College Department of Economics; 2006. Available from: http://econpapers.repec.org/RePEc:boc:bocode:s456719. [cited 2015 Mar 14].

34.

Singh H, De Coster C, Shu E, Fradette K, Latosinsky S, Pitz M, et al. Wait times from presentation to treatment for colorectal cancer: a population-based study. Can J GastroenteroL [Internet]. 2010;24:33–9. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2830632&tool=pmcentrez&rendertype=abstract.CrossRef

35.

Sheringham JR, Georghiou T, Chitnis XA, Bardsley M. Comparing primary and secondary health-care use between diagnostic routes before a colorectal cancer diagnosis: cohort study using linked data. Br J Cancer [Internet]. 2014;111:1490–9. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4200083&tool=pmcentrez&rendertype=abstract.CrossRef

36.

Young CJ, Sweeney JL, Hunter A. Implications of delayed diagnosis in colorectal cancer. Aust N Z J Surg [Internet]. 2000;70:635–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10976891.CrossRef

37.

Arbman G, Nilsson E, Störgren-Fordell V, Sjödahl R. A short diagnostic delay is more important for rectal cancer than for colonic cancer. Eur J Surg [Internet]. 1996;162:899–904. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8956960.

38.

Robinson E, Mohilever J, Zidan J, Sapir D. Colorectal cancer: incidence, delay in diagnosis and stage of disease. Eur J Cancer Clin Oncol [Internet]. 1986;22:157–61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3699078.CrossRef

39.

Ristvedt SL, Birnbaum EH, Dietz DW, Fleshman JW, Kodner IJ, Read TE. Delayed treatment for rectal cancer. Dis Colon Rectum [Internet]. 2005;48:1736–41. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3314290&tool=pmcentrez&rendertype=abstract.CrossRef

40.

Gunnarsson H, Ekholm A, Olsson LI. Emergency presentation and socioeconomic status in colon cancer. Eur J Surg Oncol [Internet]. 2013;39:831–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23692701.CrossRef

41.

McArdle CS, Hole DJ. Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg [Internet] John Wiley & Sons, Ltd. 2004;91:605–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15122613.

42.

Pollock AM, Vickers N. Deprivation and emergency admissions for cancers of colorectum, lung, and breast in south east England: ecological study. BMJ [Internet]. 1998;317:245–52. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28615&tool=pmcentrez&rendertype=abstract.CrossRef

43.

Raine R, Wong W, Scholes S, Ashton C, Obichere A, Ambler G. Social variations in access to hospital care for patients with colorectal, breast, and lung cancer between 1999 and 2006: retrospective analysis of hospital episode statistics. BMJ [Internet]. 2010;340:b5479. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2806941&tool=pmcentrez&rendertype=abstract.CrossRef

44.

Rabeneck L, Paszat LF, Li C. Risk factors for obstruction, perforation, or emergency admission at presentation in patients with colorectal cancer: a population-based study. Am J Gastroenterol [Internet]. 2006;101:1098–103. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16573783.CrossRef

45.

Esteva M, Leiva A, Ramos M, Pita-Fernández S, González-Luján L, Casamitjana M, et al. Factors related with symptom duration until diagnosis and treatment of symptomatic colorectal cancer. BMC Cancer [Internet]. 2013;13:87. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3598975&tool=pmcentrez&rendertype=abstract.CrossRef

46.

Carcaise-Edinboro P, Bradley CJ. Influence of Patient-Provider Communication on Colorectal Cancer Screening. Med Care [Internet]. 2008;46:738–45. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18580394.CrossRef

47.

Ko CW, Kreuter W, Baldwin L-M. Persistent demographic differences in colorectal cancer screening utilization despite Medicare reimbursement. BMC Gastroenterol [Internet]. 2005;5:10. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=555744&tool=pmcentrez&rendertype=abstract.CrossRef

48.

James TM, Greiner KA, Ellerbeck EF, Feng C, Ahluwalia JS. Disparities in colorectal cancer screening: a guideline-based analysis of adherence. Ethn Dis [Internet]. 2006;16:228–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16599375.

49.

Cairns CP, Viswanath K. Communication and colorectal cancer screening among the uninsured: data from the Health Information National Trends Survey (United States). Cancer Causes Control [Internet]. 2006;17:1115–25. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17006717.CrossRef

50.

Ortiz-Ortiz KJ, Rios-Motta R, Marin-Centeno H, Cruz-Correa MR, Ortiz AP. Emergency Presentation and Short-Term Survival Among Patients With Colorectal Cancer Enrolled in the Government Health Plan of Puerto Rico. Heal Serv Res Manag Epidemiol [Internet]. 2016;3:2333392816646670. Available from: http://hme.sagepub.com/lookup/doi/10.1177/2333392816646670.

51.

Morse DE, Vélez Vega CM, Psoter WJ, Vélez H, Buxó CJ, Baek LS, et al. Perspectives of San Juan healthcare practitioners on the detection deficit in oral premalignant and early cancers in Puerto Rico: a qualitative research study. BMC Public Health [Internet]. 2011;11:391. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3125369&tool=pmcentrez&rendertype=abstract.CrossRef

52.

Henry KA, Sherman R, Roche LM. Colorectal cancer stage at diagnosis and area socioeconomic characteristics in New Jersey. Health Place [Internet]. 2009;15:505–13. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19028134.CrossRef

53.

Fisher DA, Zullig LL, Grambow SC, Abbott DH, Sandler RS, Fletcher RH, et al. Determinants of medical system delay in the diagnosis of colorectal cancer within the Veteran Affairs Health System. Dig Dis Sci [Internet]. 2010;55:1434–41. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2864330&tool=pmcentrez&rendertype=abstract.CrossRef

54.

Fazio L, Cotterchio M, Manno M, McLaughlin J, Gallinger S. Association between colonic screening, subject characteristics, and stage of colorectal cancer. Am J Gastroenterol [Internet]. 2005;100:2531–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16279911.CrossRef

55.

Corkum M, Urquhart R, Kendell C, Burge F, Porter G, Johnston G. Impact of comorbidity and healthcare utilization on colorectal cancer stage at diagnosis: literature review. Cancer Causes Control [Internet] PMC Canada manuscript submission. 2012;23:213–20. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22101505.

56.

Feinstein AR. The pre-therapeutic classification of co-morbidity in chronic disease. J Chronic Dis [Internet]. 1970;23:455–68. Available from: http://www.sciencedirect.com/science/article/pii/0021968170900548.CrossRef

57.

Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res. 1974;9:208–20.PubMedPubMedCentral

58.

Ortiz AP, Cruz-Correa M. Cancer in Puerto Rico: disease burden, public policy, research and training. P R Health Sci J [Internet]. 2010;29:213–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20799506.

59.

Centers for Disease Control and Prevention (CDC). CDC–Comprehensive Cancer Control Plans–NCCCP [Internet]. 2014. Available from: http://www.cdc.gov/cancer/ncccp/ccc_plans.htm#Terr_Tribe.

Title: Factors associated with late stage at diagnosis among Puerto Rico’s government health plan colorectal cancer patients: a cross-sectional study
Authors: Karen J. Ortiz-Ortiz
Ruth Ríos-Motta
Heriberto Marín-Centeno
Marcia Cruz-Correa
Ana Patricia Ortiz
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-016-1590-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Factors associated with late stage at diagnosis among Puerto Rico’s government health plan colorectal cancer patients: a cross-sectional study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

Economic evaluation of treatments for patients with localized prostate cancer in Europe: a systematic review

Study protocol: a mixed methods study to assess mental health recovery, shared decision-making and quality of life (Plan4Recovery)

Provider attributes correlation analysis to their referral frequency and awards

Emergency Department and Inpatient Healthcare utilization due to Hypertension

Pre-contact by telephone increases response rates to postal questionnaires in a population of stroke patients: an open ended randomized controlled trial

Implementation of integration strategies between primary care units and a regional general hospital in Brazil to update and connect health care professionals: a quasi-experimental study protocol