Racial Clustering and Access to Colorectal Surgeons, Gastroenterologists, and Radiation Oncologists by African Americans and Asian Americans in the United States

Hayanga, Awori J.; Waljee, Akbar K.; Kaiser, Heather E.; Chang, David C.; Morris, Arden M.

doi:10.1001/archsurg.2009.68

Cited by 51 publications

(46 citation statements)

References 23 publications

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“…Rural residents with cancer may be at highest risk for receiving care across geographic divides, and the danger of poor collaboration may be further heightened by an oncologic workforce in these communities that is understaffed and experiences high turnover rates. [55][56][57][58][59] Although prior literature has demonstrated associations between higher patient sharing and lower cost among patients with chronic illnesses and in cancer survivorship care, 23,60 we did not find a statistically significant cost savings associated with patient sharing among the patients with stage III colon cancer in our study. There are considerable costs associated with guideline-concordant treatment for stage III colon cancer, including initiation of adjuvant chemotherapy within 4 months of diagnosis.…”

Section: Discussionmentioning

confidence: 75%

Collaboration Between Surgeons and Medical Oncologists and Outcomes for Patients With Stage III Colon Cancer

Hussain

Chang

Veenstra

et al. 2015

JOP

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Purpose: Collaboration between specialists is essential for achieving high-value care in patients with complex cancer needs. We explore how collaboration between oncologists and surgeons affects mortality and cost for patients requiring multispecialty cancer care. Patients and Methods:This was a retrospective cohort study of patients with stage III colon cancer from SEER-Medicare diagnosed between 2000 and 2009. Patients were assigned to a primary treating surgeon and oncologist. Collaboration between surgeon and oncologist was measured as the number of patients shared between them; this has been shown to reflect advice seeking and referral relationships between physicians. Outcomes included hazards for all-cause mortality, subhazards for colon cancer-specific mortality, and cost of care at 12 months.Results: A total of 9,329 patients received care from 3,623 different surgeons and 2,319 medical oncologists, representing 6,827 unique surgeon-medical oncologist pairs. As the number of patients shared between specialists increased from to one to five (25th to 75th percentile), patients experienced an approximately 20% improved survival benefit from all-cause and colon cancerspecific mortalities. Specifically, for each additional patient shared between oncologist and surgeon, all-cause mortality improved by 5% (hazard ratio, 0.95; 95%CI, 0.92 to 0.97), and colon cancerspecific mortality improved by 5% (subhazard ratio, 0.95; 95% CI, 0.91 to 0.97). There was no association with cost. Conclusion:Specialist collaboration is associated with lower mortality without increased cost among patients with stage III colon cancer. Facilitating formal and informal collaboration between specialists may be an important strategy for improving the care of patients with complex cancers.

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Section: Discussionmentioning

confidence: 75%

Collaboration Between Surgeons and Medical Oncologists and Outcomes for Patients With Stage III Colon Cancer

Hussain

Chang

Veenstra

et al. 2015

JOP

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“…Haas et al also reported that living in counties with diminished capacity for colonoscopy had a marginal association with increased late-stage CRC at the time of diagnosis. Minority populations are more likely to reside in areas with an inadequate supply of gastroenterologists, 22,36 and there is a persistent shortage of specialists, including gastroenterologists, in rural areas. 33,37 Based on the above findings, minority and rural populations could be at increased risk for late-stage CRC diagnosis and poorer outcomes.…”

Section: Discussionmentioning

confidence: 99%

Expanding Access to Colorectal Cancer Screening: Benchmarking Quality Indicators in a Primary Care Colonoscopy Program

McClellan

Ojinnaka

Pope

et al. 2015

The Journal of the American Board of Family Medicine

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Background: An inadequate supply of physicians who perform colonoscopies contributes to suboptimal screening rates, especially among the underserved. This shortage could be reduced if primary care physicians perform colonoscopies. This purpose of this article is to report quality indicators from colonoscopy procedures performed by family medicine physicians as part of a colorectal cancer prevention program targeting uninsured, low-income individuals.Methods: A grant-funded colorectal cancer screening program was implemented to increase access to affordable colonoscopies for underinsured or uninsured residents of target counties while providing colonoscopy training to family medicine resident physicians. Colonoscopies were performed or supervised by 4 board-certified family physicians. Data were collected between 2011 and 2014.Results: A total of 1155 colonoscopies were performed on 1101 individuals over a 3-year period. Cecal intubation rate was 96.25%. Adenoma detection rates among men and women >50 years old were 38.15% and 25.96%, respectively. There was 1 perforation, which was referred to a hospital, and 1 instance of postprocedural bleeding, which spontaneously resolved.

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“…12,13 More recent studies have suggested that differences in the receipt of appropriate care 7,9 and the location of care may also predict survival after treatment for cancer. [14][15][16] These studies suggest that minorities cluster for care in low-performing hospitals 17,18 or hospitals that fail to adhere to evidence based care delivery. 19 Each of these studies highlights the link between location of care, cancer survival, and disparities.…”

Section: Introductionmentioning

confidence: 99%

How Do Integrated Health Care Systems Address Racial and Ethnic Disparities in Colon Cancer?

Rhoads

Patel

et al. 2015

JCO

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Purpose Colorectal cancer (CRC) disparities have persisted over the last two decades. CRC is a complex disease requiring multidisciplinary care from specialists who may be geographically separated. Few studies have assessed the association between integrated health care system (IHS) CRC care quality, survival, and disparities. The purpose of this study was to determine if exposure to an IHS positively affects quality of care, risk of mortality, and disparities. Patients and Methods This retrospective secondary-data analysis study, using the California Cancer Registry linked to state discharge abstracts of patients treated for colon cancer (2001 to 2006), compared the rates of National Comprehensive Cancer Network (NCCN) guideline–based care, the hazard of mortality, and racial/ethnic disparities in an IHS versus other settings. Results More than 30,000 patient records were evaluated. The IHS had overall higher rates of adherence to NCCN guidelines. Propensity score–matched Cox models showed an independent and protective association between care in the IHS and survival (hazard ratio [HR], 0.87; 95% CI, 0.85 to 0.90). This advantage persisted across stage groups. Black race was associated with increased hazard of mortality in all other settings (HR, 1.15; 95% CI, 1.04 to 1.27); however, there was no disparity within the IHS for any minority group (P > .11 for all groups) when compared with white race. Conclusion The IHS delivered higher rates of evidence-based care and was associated with lower 5-year mortality. Racial/ethnic disparities in survival were absent in the IHS. Integrated systems may serve as the cornerstone for developing accountable care organizations poised to improve cancer outcomes and eliminate disparities under health care reform.

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Racial Clustering and Access to Colorectal Surgeons, Gastroenterologists, and Radiation Oncologists by African Americans and Asian Americans in the United States

Abstract: Increasing numbers of minority patients in counties is accompanied by a differential access to specialists. This may affect the likelihood of a patient to receive appropriate care.

Cited by 51 publications

References 23 publications

Collaboration Between Surgeons and Medical Oncologists and Outcomes for Patients With Stage III Colon Cancer

Collaboration Between Surgeons and Medical Oncologists and Outcomes for Patients With Stage III Colon Cancer

Expanding Access to Colorectal Cancer Screening: Benchmarking Quality Indicators in a Primary Care Colonoscopy Program

How Do Integrated Health Care Systems Address Racial and Ethnic Disparities in Colon Cancer?

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