Assessing racial/ethnic disparities in colorectal cancer postoperative care

Abstract

University of Washington Abstract Assessing racial/ethnic disparities in colorectal cancer postoperative care Janeth Sanchez Chair of Supervisory Committee: Engelberta Thompson, Professor Emeritus Department of Health Services, School of Public Health Surveillance after surgically resected colorectal cancer (CRC) is a vital clinical process that allows for the early detection of recurrence, especially among 40% of CRC survivors who are likely to develop recurrence after definitive surgical resection for primary CRC [1, 2]. If detected early, the recurrent disease may be responsive to potentially effective cancer treatment [1-3]. National guidelines recommend routine surveillance with colonoscopy, carcinoembryonic antigen (CEA) tests, and computed tomography (CT) scans for patients diagnosed with CRC stages II and III [4, 5]. Unfortunately, surveillance procedures are underutilized among CRC patients and racial/ethnic minorities are about 30% less likely to receive recommended surveillance procedures compared to non-Hispanic Whites [6-12]. This research expands on previous studies and assesses the association between key sociodemographic and economic factors that measure access to care and receipt of colonoscopy (Aim 1) and receipt of CEA tests and CT scans (Aim 2) across racial/ethnic groups. This research also describes the characteristics of CRC patients with recurrence and their surveillance behaviors (Aim 3). These are retrospective population-based cohort studies using the National Cancer Institutes’ Surveillance, Epidemiology and End Results (SEER) – Medicare linked data collected from 2009 to 2014. Medicare beneficiaries who received surgical resection for CRC adenocarcinoma diagnosed with documented pathologically staged II and III single CRC as their first cancer between the ages of 66 and 85 were included in these studies. Statistical analyses include multivariate and multilevel logistic regression models. Receipt of initial surveillance procedures remain low, especially for colonoscopies (57.5%) and CT scans (58.2%). In our study, 12.2% of patients had recurrent disease after 18-months following surgical resection and only 43.7% of these patients had received a colonoscopy, CEA tests, and a CT scan as recommended by national clinical guidelines. Disparities in receipt of surveillance colonoscopy exist among Blacks and NHW patients. There were no significant racial/ethnic differences in receipt of CEA tests or a CT scan. In addition to patient characteristics (predisposing factors) and clinical (need) factors, socioeconomic measures of access to care (enabling factors) are significantly associated with receipt of surveillance procedures. In addition to clinical factors, Black neighborhood density was significantly associated with recurrence. Results suggest inequitable access to surveillance procedures within and between racial/ethnic groups. Findings from this research may help guide future public health and clinical interventions focused on improving the timely receipt of surveillance procedures among older adults who are likely to have limited access to recommended CRC care. In addition, characterizing patients diagnosed with recurrent or metastatic disease and assessing their surveillance behaviors is a first step for developing effective surveillance promotion interventions and improving cancer treatments for these patients.