Association Between Primary Payer Status and Survival in Patients With Stage III Colon Cancer: An National Cancer Database Analysis

Ahmed, Aabra; Tahseen, Ahmed Ibrahim; England, Elizabeth C; Wolfe, Katrine; Simhachalam, Michael; Homan, Travis; Sitenga, Jenna; Walters, Ryan W.; Silberstein, Peter T.

doi:10.1016/j.clcc.2018.09.004

Cited by 10 publications

(8 citation statements)

References 20 publications

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“…with Medicare to have 14% decreased mortality risk compared with underinsured patients, which may be attributed to increased use of AC in our study [21]. Similar to work by Bradley et al, who reported that underinsured patients were approximately 50% less likely than Medicare patients to initiate or complete AC, we found that uninsured patients and Medicaid recipients, patients with limited income and resources who receive government-funded medical assistance, had lower AC use [25].…”

Section: Ahmed Et Al Previously Reported Stage III Colon Cancer Patientssupporting

confidence: 83%

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N1c colon cancer and the use of adjuvant chemotherapy: a current audit of the National Cancer Database

et al. 2020

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Aim: Colorectal cancer staging has evolved to define N1c as the presence of tumour deposits without concurrent positive lymph nodes. Work to date reports poor prognosis in N1c colon cancer, with Stage III categorization and adjuvant chemotherapy (AC) recommended. No study has yet evaluated the prevalence, treatment compliance or treatmentrelated outcomes on a national scale. We aimed to evaluate the prevalence of N1c colon cancer, use, outcomes and factors associated with AC in the USA. Method: The National Cancer Database was reviewed for N1cM0 colon adenocarcinomas that underwent resection from 2010 to 2016. Cases were stratified into 'AC' or 'no AC' cohorts. The Kaplan-Meier method was used to estimate overall survival (OS) and compare the AC and no AC cohorts using the log-rank test. Multivariable logistic regression identified factors associated with AC. The main outcome measures were the prevalence and factors associated with AC use and its impact in N1c disease. Results: Of the 5684 (1.59% of 357 752) colon adenocarcinomas that were N1c, 55% (n = 3071) received AC. AC significantly improved 1-, 3-and 5-year OS compared with no AC (96.2%, 80%, 67.4% and 72.9%, 48.5%, 33.8%, respectively; P < 0.001). Compared with the no AC group, AC patients were younger, had less comorbidity, were of the male gender and received minimally invasive surgery at an academic treatment centre (all P < 0.05). Socioeconomic and procedural factors significantly impacted the use of AC. Conclusion: In the USA, AC is underutilized in N1c colon cancer despite significantly improved OS. Socioeconomic and procedural factors associated with AC were identified, highlighting disparities in AC use and opportunities to improve oncological outcomes and survival.

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Section: Ahmed Et Al Previously Reported Stage III Colon Cancer Patientssupporting

confidence: 83%

“…Disparities in treatment for Stage III colon cancer have been previously described, although not related to N1c disease [21][22][23][24][25][26]. We found advancing age, major comorbidity and longer LOS associated with decreased likelihood of AC.…”

Section: Discussionsupporting

confidence: 54%

N1c colon cancer and the use of adjuvant chemotherapy: a current audit of the National Cancer Database

et al. 2020

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“…Ahmed et al performed a retrospective review which noted that stage III colon cancer patients with private insurance and greater socioeconomic status were associated with increased survival compared with other insurance plans/uninsured patients. 10 Annie et al performed a retrospective review of cancer registries looking at insurance status as it related to the colon, bladder, anal, rectal, and esophageal cancers and concluded that the payer type did not alter survival. 5 This study assessed multiple different cancer types (anal, rectal, and esophageal were all combined into 1 cohort) which make the conclusions difficult to apply to a subset; however, it was the first of its kind to deem that the payer source did not affect survival.…”

Section: Discussionmentioning

confidence: 99%

Insurance Status in Rectal Cancer is Associated With Age at Diagnosis and May be Associated With Overall Survival

Bridges

Honaker

Smith

et al. 2020

The American Surgeon™

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Background There are approximately 44 180 new cases of rectal cancer diagnosed annually. While surgical resection remains the standard of care for definitive treatment, neoadjuvant chemoradiation therapy (NCRT) has significantly reduced recurrence rates postoperatively. NCRT is indicated for T3/T4 tumors, and relative indications include patients with T1/T2 lesions with clinically positive nodes. While this remains the standard of care, all patients may not receive equal treatment for their rectal cancer depending on various healthcare disparities. We aimed to discover how insurance status affected rectal cancer patients’ time of diagnosis to treatment, age of diagnosis, and overall vitality. Methods A single-center retrospective chart and cancer registry review was performed for all patients diagnosed with rectal cancer of any stage between 2011 and 2018. A total of 94 rectal cancer patients were included in the analysis. Age, race, sex, insurance status, vitality, and grade were assessed. Time in days of diagnosis to the time of first treatment (neoadjuvant chemotherapy or radiation) was measured. Continuous variables were reported as means and SDs or medians and interquartile ranges and were analyzed with the unpaired t-test or Mann-Whitney U-test. Categorical variables were reported as frequencies and percentages and were analyzed with Fisher’s exact test. Statistical significance was determined with a P < .05. All analyses were conducted using SAS version 9.4 (SAS Institute, Cary, NC, USA). Results Total race breakdown was as follows: white (61%), African-American (30%), and other (3%). There was no statistically significant difference in diagnosis time to first treatment in the uninsured versus insured groups ( P = .9). There was a statistically significant difference in the age of diagnosis with insured mean age of 60.9 years and uninsured mean age of 52.4 years ( P = .0080). There was no statistically significant difference in survival between the 2 groups ( P = .54). For those who went onto have surgery, there was no difference in the median number of lymph nodes harvested between the 2 groups ( P = .73). Conclusion Insurance status did not affect timing to treatment or survival. Uninsured patients had a younger age of diagnosis by approximately 8 years on average. Uninsured patients received the same quality surgeries as uninsured patients in regard to lymph node harvests.

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“…Although the impact of socioeconomic status on the incidence, staging, and survival of colorectal cancer has been well-documented in the literature, research has yet to derive a consistent conclusion regarding the numerous impacts due to international disparities in culture and healthcare systems. Although most studies have corroborated the finding that individuals with lower socioeconomic status are at higher risk of colorectal cancer [7][8][9][10][11], more likely to be diagnosed with late-stage colorectal cancer [8,[12][13][14], and prone to lower survival outcomes [15][16][17][18][19][20][21][22][23][24], numerous studies in countries with universal health insurance coverage have indicated that socioeconomic status has no significant impact on the incidence [25,26] and stage of colorectal cancer at diagnosis [27,28].…”

Section: Introductionmentioning

confidence: 99%

Impact of Socioeconomic Status on Cancer Incidence Risk, Cancer Staging, and Survival of Patients with Colorectal Cancer under Universal Health Insurance Coverage in Taiwan

Kuo

Hsu

Kung

et al. 2021

IJERPH

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This study examined the impact of socioeconomic status on colorectal cancer risk, staging, and survival under the National Health Insurance (NHI) system in Taiwan. Monthly salary and education level were used as measures of socioeconomic status to observe the risk of colorectal cancer among individuals aged 40 years or above in 2006–2015 and survival outcomes of patients with colorectal cancer until the end of 2016. Data from 286,792 individuals were used in this study. Individuals with a monthly salary ≤Q1 were at a significantly lower incidence risk of colorectal cancer than those with a monthly salary >Q3 (HR = 0.80, 95% CI = 0.74–0.85), while those with elementary or lower education were at a significantly higher risk than those with junior college, university, or higher education (HR = 1.18, 95% CI = 1.06–1.31). The results show that socioeconomic status had no significant impact on colorectal cancer stage at diagnosis. Although salary was not associated with their risk of mortality, patients with colorectal cancer who had elementary or lower education incurred a significantly higher risk of mortality than those who had junior college, university, or higher education (HR = 1.39, 95% CI = 1.07–1.77). Education level is a significant determinant of the incidence risk and survival in patients with colorectal cancer, but only income significantly impacts incidence risk.

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Association Between Primary Payer Status and Survival in Patients With Stage III Colon Cancer: An National Cancer Database Analysis

Cited by 10 publications

References 20 publications

N1c colon cancer and the use of adjuvant chemotherapy: a current audit of the National Cancer Database

N1c colon cancer and the use of adjuvant chemotherapy: a current audit of the National Cancer Database

Insurance Status in Rectal Cancer is Associated With Age at Diagnosis and May be Associated With Overall Survival

Impact of Socioeconomic Status on Cancer Incidence Risk, Cancer Staging, and Survival of Patients with Colorectal Cancer under Universal Health Insurance Coverage in Taiwan

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