A black‐white comparison of the quality of stage‐specific colon cancer treatment

Berry, Jamillah; Caplan, Lee S.; Davis, Sharon; Minor, Patrick; Counts-Spriggs, Margaret; Glover, Roni; Ogunlade, Vickie; Bumpers, Kevin; Kauh, John S.; Brawley, Otis W.; Flowers, Christopher R.

doi:10.1002/cncr.24757

Cited by 22 publications

(22 citation statements)

References 41 publications

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“…In addition, our analysis indicated an increased risk of death for patients with insurance status other than private insurance among patients who had stage III and high‐risk stage II disease and did not received treatment in adherence to NCCN guidelines (ie, with surgery alone). Similar survival trends relating to insurance status and demographic factors have been noted in several other studies 30‐34…”

Section: Discussionsupporting

confidence: 84%

Association between adherence to National Comprehensive Cancer Network treatment guidelines and improved survival in patients with colon cancer

Boland

Chang

Haynes

et al. 2012

Cancer

186

159

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BACKGROUND: The objective of the current study was to examine the impact of adherence to guidelines on stage‐specific survival outcomes in patients with stage III and high‐risk stage II colon cancer. The National Comprehensive Cancer Network (NCCN) has established working, expert consensus, and evidence‐based guidelines for organ‐specific cancer care, including care of patients with colon cancer. METHODS: Patients who were diagnosed with colon adenocarcinoma between 1998 and 2002 were selected from within the National Cancer Data Base. The cohort was limited to patients who received their first course of treatment at the reporting facility. Pathologic variables, including tumor depth, lymph node status, and evidence of metastatic disease, were used to restage patients, and the patients were divided into low‐risk and high‐risk categories on the basis of criteria defined by the NCCN. Relative survival rates were calculated for the entire cohort, stratified according to adherence versus nonadherence to NCCN treatment guidelines. RESULTS: In univariate analysis of treatment adherence patterns for both patient subgroups (high‐risk stage II and stage III), several factors were associated with a higher rate of nonadherence in both groups, including older age (P < .001); Medicaid, Medicare, or uninsured status versus private insurance (P < .001); and subsequent treatment at a facility other than the facility at which the cancer was first diagnosed (P < .001). In multivariate analysis, multiple factors were associated with differences in relative survival, although analyses that included the year of diagnosis did not demonstrate significant differences over time. CONCLUSIONS: The current study documented practice patterns in a heterogeneous population of patients with colon cancer and demonstrated a survival benefit for patients with stage III and high‐risk stage II colon cancer who received treatment that adhered to NCCN guidelines. These data validate the current NCCN practice guidelines for colon cancer and support the concept of guideline‐based metrics that can be compared across institutions to assess the quality of cancer care and to compare the quality of cancer care among institutions. Cancer 2013. © 2012 American Cancer Society.

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Section: Discussionsupporting

confidence: 84%

Association between adherence to National Comprehensive Cancer Network treatment guidelines and improved survival in patients with colon cancer

Boland

Chang

Haynes

et al. 2012

Cancer

186

159

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“…Similar to the current study, their report demonstrated no racial difference in the receipt of oxaliplatin . Because these studies suggest there is no racial disparity in the receipt of chemotherapy, questions remain concerning the reasons why AA patients with CC still have worse outcomes and survival compared with white patients . Although Edwards et al demonstrated that a decline in mortality from colorectal cancer is largely a result of improvements in risk factors and an increased screening rate, Sineshaw et al associated improved survival from CC with access to new treatments …”

Section: Discussionsupporting

confidence: 74%

“…In addition, although non‐CCOP practices may be less likely to provide access to postsurgical evidence‐based adjuvant therapy for stage III CC, AAs treated in CCOPs may be more likely to receive guideline‐concordant treatment . Recognizing and addressing barriers to access are ways to decrease racial disparities in outcomes …”

Section: Discussionmentioning

confidence: 99%

“…There are demonstrated disparities in incidence, treatment, and survival due to differential access and treatment use in colorectal cancer care between AAs and whites . AAs with colorectal cancer are less likely to undergo screening and are diagnosed at later stages than white patients, resulting in poorer outcomes . In a recent American Cancer Society study of patients with metastatic colorectal cancer, AAs were found to have less survival improvement than whites, which the authors suggested reflects unequal access to new treatments .…”

Section: Introductionmentioning

confidence: 99%

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Provider‐based research networks may improve early access to innovative colon cancer treatment for African Americans treated in the community

Penn

Chang

Meyer

et al. 2014

Cancer

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Background African Americans (AA) with colon cancer (CC) experience worse outcomes than Caucasian Americans (CA) partly due to differential treatment. The National Cancer Institute's (NCI) Community Clinical Oncology Program (CCOP), a provider-based research network (PBRN), adopts and diffuses innovative CC treatments quickly. We hypothesized that CCOP participation would lessen racial differences in receipt of oxaliplatin, innovative CC treatment, for patients with stage III CC in the community. Methods Using SEER-Medicare data, we performed a population-based retrospective cohort study of AA and CA individuals ≥66years diagnosed with stage III CC from 2003-2005. We used generalized estimating equations to calculate odds of receiving an oxaliplatin-containing regimen. Predicted probabilities of oxaliplatin receipt for race-CCOP combinations were calculated. The absolute difference in oxaliplatin receipt between races was estimated using interaction contrast ratio (ICR). Results Of 2,971 included individuals, 36% received oxaliplatin, 29.5% were CCOP-affiliated, and 7.6% were AA. In multivariate analysis, early diffusion of oxaliplatin was not associated with race or CCOP participation. The probability of receiving oxaliplatin for CCOP AAs (0.46) almost doubled that of non-CCOP AAs (0.25,p<0.05). For CAs the probabilities of receiving oxaliplatin did not differ by CCOP participation. For oxaliplatin receipt, the joint effects assessment suggested a greater benefit of CCOP participation among AAs (ICR=1.7). Conclusions Among older stage III CC patients there is a differential impact of race on oxaliplatin receipt depending on CCOP participation. AAs treated by CCOPs were more likely to receive oxaliplatin than AAs treated elsewhere. PBRNs may facilitate early access to innovative treatment for AAs with stage III CC.

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“…This approach followed the Institute of Medicine's recommendation that central cancer registries be linked to claims and hospital discharge files to provide state or national data on the quality of cancer care [7], and built on the Institute of Medicine's Committee on Assessing Improvements in Cancer Care in Georgia report which translated care quality guidelines into specific metrics that could be applied at the state level [8]. Although other studies have evaluated concordance with guideline therapy for colorectal cancer [6,[9][10][11][12][13][14][15][16][17][18][19], what is unique about this study is its inclusion of the Medicaid population with Medicaid claims data. Quality of care studies indicate that care is inferior for vulnerable populations, including racial and ethnic minorities [20].…”

Section: Introductionmentioning

confidence: 99%

Measuring colorectal cancer care quality for the publicly insured in New York State

et al. 2012

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The extent to which concordance with colorectal cancer treatment quality metrics varies by patient characteristics in the publicly insured is not well understood. Our objective was to evaluate the quality of colorectal cancer care for publicly insured residents of New York State (NYS). NYS cancer registry data were linked to Medicaid and Medicare claims and hospital discharge data. We identified colorectal cancer cases diagnosed from 2004 through 2006 and evaluated three treatment quality measures: adjuvant chemotherapy within 4 months of diagnosis for American Joint Cancer Committee (AJCC) stage III colon cancer, adjuvant radiation within 6 months of diagnosis for AJCC stage IIB or III rectal cancer, and adjuvant chemotherapy within 9 months of diagnosis for AJCC stage II–III rectal cancer. Concordance with guidelines was evaluated separately for Medicaid-enrollees under age 65 years and Medicare-enrollees aged 65–79 years. For adjuvant chemotherapy for colon cancer, 79.4% (274/345) of the Medicaid cohort and 71.8% (585/815) of the Medicare cohort were guideline concordant. For adjuvant radiation for rectal cancer, 72.3% (125/173) of the Medicaid cohort and 66.9% (206/308) of the Medicare cohort were concordant. For adjuvant chemotherapy for rectal cancer, 89.5% (238/266) of the Medicaid cohort and 76.0% (392/516) of the Medicare cohort were concordant. Younger age was associated with higher adjusted odds of concordance for all three measures in the Medicare cohort. Racial differences were not evident in either cohort. There is room for improvement in concordance with accepted metrics of cancer care quality. Feedback about performance may assist in targeting efforts to improve care.

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A black‐white comparison of the quality of stage‐specific colon cancer treatment

Cited by 22 publications

References 41 publications

Association between adherence to National Comprehensive Cancer Network treatment guidelines and improved survival in patients with colon cancer

Association between adherence to National Comprehensive Cancer Network treatment guidelines and improved survival in patients with colon cancer

Provider‐based research networks may improve early access to innovative colon cancer treatment for African Americans treated in the community

Measuring colorectal cancer care quality for the publicly insured in New York State

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