Treatment at Academic Centers Decreases Insurance-Based Survival Disparities in Colon Cancer

Cabo, Jackson; Shu, Xiang; Parikh, Alexander A.; Bailey, Christina E.

doi:10.1016/j.jss.2019.07.059

Cited by 14 publications

(11 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We note that the majority of both non‐Black and Black patients are managed at HVCs based on Leapfrog Group criterion, but there remains a quartile of patients that undergo surgical resection at LVCs. Importantly, our study does not appear to support prior claims that Black patients are less likely to seek out HVC care as the rates of HVC utilization are similar (15.2% vs. 15.9%) between the two race cohorts 6 . Both non‐Black and Black patients managed at HVCs had fewer comorbidities, and the majority of HVCs at which both non‐Black and Black patients were managed were academic institutions.…”

Section: Discussioncontrasting

confidence: 94%

“…Despite improvement in mortality and survival, racial disparities for Black patients continue to impact postoperative and survival outcomes across abdominal malignancies 1–15 . Even so, some studies have identified socioeconomic factors and factors associated with access to quality cancer care, such as insurance status, income, and hospital surgical volume, and academic status may also contribute to these disparities 6,7,14,14,15,20 . Hospital surgical volume and improvements in postoperative care at quality‐driven facilities have been associated with improved postoperative outcomes in multiple cancer types 7,21–29 .…”

Section: Discussionmentioning

confidence: 99%

“…From 2012 to 2016, Black patients had age‐adjusted mortality rates of 190.6/100,000 and 19.4/100,000 persons for all‐site and colorectal cancers, respectively, rates significantly higher than their White counterparts 2,3 . Such racial disparities for Black patients remain pervasive across multiple different solid malignancies managed with surgical resection even after adjustment for stage of disease and treatment 4–15 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The impact of hospital volume on racial disparities in resected rectal cancer

Shannon

Straker

Keele

et al. 2021

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background Although high volume centers (HVC) equate to improved outcomes in rectal cancer, the impact of surgical volume related to race is less defined. Methods Patients who underwent surgical resection for stage I–III rectal adenocarcinoma were divided into cohorts based on race and hospital surgical volume. Outcomes were analyzed following 1:1 propensity‐score matching using logistic, Poisson, and Cox regression analyses with marginal effects. Results Fifty‐four thousand one hundred and eighty‐four (91.5%) non‐Black and 5043 (8.5%) Black patients underwent resection of rectal cancer. Following 1:1 matching of non‐Black (N = 5026) and Black patients, 5‐year overall survival (OS) of Black patients was worse (72% vs. 74.4%, average marginal effects [AME] 0.66, p = 0.04) than non‐Black patients. When compared to non‐Black patients managed at HVCs, Black patients had worse OS (70.1% vs. 74.7%, AME 1.55, p = 0.03), but this difference was not significant when comparing OS between non‐Black and Black patients managed at HVCs (72.3% vs. 74.7%, AME 0.62, p = 0.06). Length of stay was longer among Black and HVC patients across all cohorts. There was no difference across cohorts in 90‐day mortality. Conclusions Although racial disparities exist in rectal cancer, this disparity appears to be ameliorated when patients are managed at HVCs.

show abstract

Section: Discussioncontrasting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The impact of hospital volume on racial disparities in resected rectal cancer

Shannon

Straker

Keele

et al. 2021

Journal of Surgical Oncology

View full text Add to dashboard Cite

show abstract

“…While there is no reported literature to date specific to rectal cancer, Cabo et al discovered that for colon cancer patients' treatment at academic centers seemed to have improved overall survival among the 2 groups indicating academic centers may offer improved care for uninsured. 8 Given that our study was performed at a teaching hospital, our data further support this; however, further research is warranted in regard to how this may apply to rectal cancer as opposed to colon cancer. Pulte et al suggested that colon cancer patients with Medicaid or uninsured were more likely to have metastatic cancer as opposed to insured patients.…”

Section: Discussionsupporting

confidence: 60%

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™

View full text Add to dashboard Cite

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.

show abstract

“…Interestingly, regardless of income and race or ethnic origin, patients in metropolitan areas seemed to have a lower risk of death compared with those living in rural areas, presumably because of greater access to care, especially at centers of excellence with significant expertise (academic vs. nonacademic), and more clinical trial opportunities [29, 30].…”

Section: Discussionmentioning

confidence: 99%

Impact of Sociodemographic Disparities and Insurance Status on Survival of Patients with Early-Onset Colorectal Cancer

et al. 2021

View full text Add to dashboard Cite

Background. Low socioeconomic status (SES) has been linked to worse survival in patients with colorectal cancer (CRC); however, the impact of SES on early-onset CRC remains undescribed. Methods. Retrospective analysis of data from the National Cancer Database (NCDB) between 2004 and 2016 was conducted. We combined income and education to form a composite measure of SES. Logistic regression and chisquared testing were used to examine early-onset CRC according to SES group. Survival rates and Cox proportional hazards models compared stage-specific overall survival (OS) between the SES groups. Results. In total, 30,903 early-onset CRC patients were identified, of whom 78.7% were White; 14.5%, Black. Low SES compared to High SES patients, were more likely to be Black (26.3% vs. 6.1%) or Hispanic (25.3% vs. 10.5%), have T4 tumors (21.3% vs. 17.8%), N2 disease (13% vs. 11.1%), and present with stage IV disease (32.8% vs. 27.7%) at diagnosis (p<0.0001, all comparisons). OS gradually improved with increasing SES at all disease stages (p<0.001). In stage IV, the 5-year survival rate was 13.9% vs. 21.7% for patients with low compared to high SES. In multivariable analysis, SES (low vs. high group; HR adj =1.35, 95% CI 1.26 -1.46) was found to have a significant effect on survival (p<0.0001) when all of the confounding variables were adjusted. Insurance (no private vs. private; HR adj = 1.38 (1.31-1.44)) mediates 31% of the SES effect on survival. Conclusions. Early-onset CRC patients with low SES had the worst outcomes. Our data suggest that SES should be considered when implementing programs to improve the early detection and treatment of patients with early-onset CRC. The Oncologist 2021;9999:• • Implications for Practice: Low socioeconomic status (SES) has been linked to worse survival in patients with colorectal cancer (CRC); however, the impact of SES on early-onset CRC remains undescribed. In this retrospective study of 30,903 patients with early-onset CRC in the National Cancer Database, a steady increase in the yearly rate of stage IV-diagnosis at presentation was observed. The risk of death increased as socioeconomic status decreased. Race and insurance status were independent predictors for survival. Implementation of programs to improve access to care and early diagnostic strategies among younger adults, especially those with low SES, is warranted.

show abstract

Treatment at Academic Centers Decreases Insurance-Based Survival Disparities in Colon Cancer

Cited by 14 publications

References 31 publications

The impact of hospital volume on racial disparities in resected rectal cancer

The impact of hospital volume on racial disparities in resected rectal cancer

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

Impact of Sociodemographic Disparities and Insurance Status on Survival of Patients with Early-Onset Colorectal Cancer

Contact Info

Product

Resources

About