The influence of employer-based health insurance and job support on receipt of adjuvant chemotherapy in stage III colorectal cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 278-278
Author(s):  
Christine Marie Veenstra ◽  
Scott E. Regenbogen ◽  
Sarah T. Hawley ◽  
Mousumi Banerjee ◽  
Ikuko Kato ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Insurance ◽  
Adjuvant Chemotherapy ◽  
Insurance Coverage ◽  
Stage Iii ◽  
Medical Illness ◽  
Recommended Care ◽  
Job Support ◽  
Catchment Areas ◽  
To Receive

278 Background: Approximately 15% of the U.S. population lacks health insurance. Adjuvant chemotherapy confers significant survival benefit in stage III colorectal cancer (CRC), yet many patients fail to receive recommended care. We hypothesized that access to employer-based health insurance (EBHI) and other job-related support programs influences receipt of chemotherapy. Methods: We performed a population-based survey of patients diagnosed with stage III CRC in the state of Georgia and Metropolitan Detroit SEER catchment areas. The primary outcome was receipt of adjuvant chemotherapy. Patients were queried regarding clinical, sociodemographic, and employment characteristics (EBHI and job support - e.g., sick leave, disability, flexible schedule, unpaid time off). We used χ2 analyses to examine associations between health insurance coverage, job support availability and receipt of chemotherapy, adjusting for other characteristics. Results: To date, 630 patients have responded (preliminary response rate=56%). 257 (41%) were working for pay at diagnosis, of whom 46% had EBHI and 9% had no insurance at all. Rates of chemotherapy receipt were higher among those with EBHI than those without (97% vs. 90%, P=0.001). 26% with EBHI reported that they kept their job mainly to keep insurance. 79% of those working for pay reported some form of available job support. Rates of chemotherapy receipt were higher among employed respondents with job support compared to those without (97% vs. 85%, P<0.001). Availability of job support was significantly associated with ability to retain employment; 48% of those without support stopped working altogether because of CRC vs. only 11% of those with support (P<0.001). Conclusions: Patients with EBHI and job support were significantly more likely to receive recommended adjuvant chemotherapy after surgery for stage III CRC. Further, lack of job-related support for medical illness was significantly associated with loss of employment for patients undergoing treatment for CRC. These findings suggest that employer-based health insurance and job support are important contributors to receipt of recommended cancer care.

scholarly journals 807Association between diabetes and adjuvant chemotherapy implementation among patients with stage III colorectal cancer

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Rieko Kanehara ◽  
Atsushi Goto ◽  
Tomone Watanabe ◽  
Kosuke Inoue ◽  
Masataka Taguri ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Postoperative Complications ◽  
Mediation Analysis ◽  
Claims Data ◽  
Health Claims ◽  
Stage Iii ◽  
Implementation Rate ◽  
Health Claims Data ◽  
To Receive

Abstract Background Preexisting diabetes may contribute to the indication for adjuvant chemotherapy among patients with colorectal cancer (CRC); however, the association between diabetes and its implementation is largely unknown. Methods We analyzed the hospital-based cancer registry and health claims data of patients with stage III CRC who received curative surgery in 2013 in Japan (n = 6,344). Chemotherapy and diabetes was identified based on procedure, prescription, and diabetes codes in claims data. We examined the association between diabetes and implementation rate of adjuvant chemotherapy using the generalized linear model adjusted for age, sex, and updated Charlson Comorbidity Index, hospital type, and prefecture. We further applied a mediation analysis to examine the extent to which postoperative complications mediated the association. Results Of these, 1,236 (19.5%) had diabetes. Compared with those without diabetes, patients with diabetes were less likely to receive adjuvant chemotherapy (crude rate: 58.9% and 49.8%; adjusted percentage point difference: 4.7% [95% confidence limits: 1.7, 7.5]). Mediation analysis indicated that postoperative complications explained 9.4% of the association between diabetes and adjuvant chemotherapy implementation. Conclusions Our findings suggest that patients with stage III CRC and diabetes are less likely to receive adjuvant chemotherapy than those without diabetes, and postoperative complications may partially account for the association. Key messages Concomitant diabetes might negatively impact the implementation rate of adjuvant chemotherapy in patients with stage III CRC.

scholarly journals Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States

PLoS Medicine ◽  
2021 ◽  
Vol 18 (10) ◽  
pp. e1003842
Author(s):  
Scarlett Hao ◽  
Rebecca A. Snyder ◽  
William Irish ◽  
Alexander A. Parikh
Keyword(s):  
United States ◽  
Colon Cancer ◽  
Health Insurance ◽  
Adjuvant Chemotherapy ◽  
Racial Disparities ◽  
Private Insurance ◽  
Insurance Coverage ◽  
The United States ◽  
Treatment Disparities ◽  
To Receive

Background Both health insurance status and race independently impact colon cancer (CC) care delivery and outcomes. The relative importance of these factors in explaining racial and insurance disparities is less clear, however. This study aimed to determine the association and interaction of race and insurance with CC treatment disparities. Study setting Retrospective cohort review of a prospective hospital-based database. Methods and findings In this cross-sectional study, patients diagnosed with stage I to III CC in the United States were identified from the National Cancer Database (NCDB; 2006 to 2016). Multivariable regression with generalized estimating equations (GEEs) were performed to evaluate the association of insurance and race/ethnicity with odds of receipt of surgery (stage I to III) and adjuvant chemotherapy (stage III), with an additional 2-way interaction term to evaluate for effect modification. Confounders included sex, age, median income, rurality, comorbidity, and nodes and margin status for the model for chemotherapy. Of 353,998 patients included, 73.8% (n = 261,349) were non-Hispanic White (NHW) and 11.7% (n = 41,511) were non-Hispanic Black (NHB). NHB patients were less likely to undergo resection [odds ratio (OR) 0.66, 95% confidence interval [CI] 0.61 to 0.72, p < 0.001] or to receive adjuvant chemotherapy [OR 0.83, 95% CI 0.78 to 0.87, p < 0.001] compared to NHW patients. NHB patients with private or Medicare insurance were less likely to undergo resection [OR 0.76, 95% CI 0.63 to 0.91, p = 0.004 (private insurance); OR 0.59, 95% CI 0.53 to 0.66, p < 0.001 (Medicare)] and to receive adjuvant chemotherapy [0.77, 95% CI 0.68 to 0.87, p < 0.001 (private insurance); OR 0.86, 95% CI 0.80 to 0.91, p < 0.001 (Medicare)] compared to similarly insured NHW patients. Although Hispanic patients with private and Medicare insurance were also less likely to undergo surgical resection, this was not the case with adjuvant chemotherapy. This study is mainly limited by the retrospective nature and by the variables provided in the dataset; granular details such as continuity or disruption of insurance coverage or specific chemotherapy agents or dosing cannot be assessed within NCDB. Conclusions This study suggests that racial disparities in receipt of treatment for CC persist even among patients with similar health insurance coverage and that different disparities exist for different racial/ethnic groups. Changes in health policy must therefore recognize that provision of insurance alone may not eliminate cancer treatment racial disparities.

The efficacy of adjuvant chemotherapy for resected high-risk stage II and stage III colorectal cancer in frail patients

2021 ◽  
Author(s):  
Kosuke Mima ◽  
Nobutomo Miyanari ◽  
Keisuke Kosumi ◽  
Takuya Tajiri ◽  
Kosuke Kanemitsu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Stage Ii ◽  
Stage Iii ◽  
Frail Patients

Clinical and Socioeconomic Factors that Predict Non-completion of Adjuvant Chemotherapy for Colorectal Cancer in a Rural Cancer Center

2022 ◽  
pp. 000313482110547
Author(s):  
Chelsea Knotts ◽  
Alexandra Van Horn ◽  
Krysta Orminski ◽  
Stephanie Thompson ◽  
Jacob Minor ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Socioeconomic Factors ◽  
Cancer Patients ◽  
Private Insurance ◽  
Stage Ii ◽  
Stage Iii ◽  
Insurance Status ◽  
Complete Treatment ◽  
Colorectal Cancer Patients

Background Previous literature demonstrates correlations between comorbidities and failure to complete adjuvant chemotherapy. Frailty and socioeconomic disparities have also been implicated in affecting cancer treatment outcomes. This study examines the effect of demographics, comorbidities, frailty, and socioeconomic status on chemotherapy completion rates in colorectal cancer patients. Methods This was an observational case-control study using retrospective data from Stage II and III colorectal cancer patients offered chemotherapy between January 01, 2013 and January 01, 2018. Data was obtained using the cancer registry, supplemented with chart review. Patients were divided based on treatment completion and compared with respect to comorbidities, age, Eastern Cooperative Oncology Group (ECOG) score, and insurance status using univariate and multivariate analyses. Results 228 patients were identified: 53 Stage II and 175 Stage III. Of these, 24.5% of Stage II and 30.3% of Stage III patients did not complete chemotherapy. Neither ECOG status nor any comorbidity predicted failure to complete treatment. Those failing to complete chemotherapy were older (64.4 vs 60.8 years, P = .043). Additionally, those with public assistance or self-pay were less likely to complete chemotherapy than those with private insurance ( P = .049). Both factors (older age/insurance status) remained significant on multivariate analysis (increasing age at diagnosis: OR 1.03, P =.034; public insurance: OR 1.84, P = .07; and self-pay status: OR 4.49, P = .03). Conclusions No comorbidity was associated with failure to complete therapy, nor was frailty, as assessed by ECOG score. Though frailty was not significant, increasing age was, possibly reflecting negative attitudes toward chemotherapy in older populations. Insurance status also predicted failure to complete treatment, suggesting disparities in access to treatment, affected by socioeconomic factors.

Jagged-1 Expression Level Is Correlated With Recurrence of Stage III Colorectal Cancer in Patients Receiving Adjuvant Chemotherapy

2021 ◽  
Vol 41 (9) ◽  
pp. 4645-4650
Author(s):  
HONG-BEUM KIM ◽  
SEUL-BI LEE ◽  
SEONG-JUNG KIM ◽  
HEE-JEONG LEE ◽  
SANG-GON PARK
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Expression Level ◽  
Stage Iii

Adherence to clinical practice guidelines for adjuvant chemotherapy for colorectal cancer in Uruguay: A population-based study.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 53-53
Author(s):  
Santiago Fontes ◽  
Ana Marín-Jiménez ◽  
Megan Berry ◽  
Mauricio Cuello ◽  
Juan Carlos Sánchez ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Clinical Practice ◽  
Adjuvant Chemotherapy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Population Based ◽  
Stage Iii ◽  
Disease Stage ◽  
Curative Intent ◽  
Factors Associated

53 Background: Despite surgery, the 5-year risk of systemic recurrence of colorectal cancer (CRC) in the absence of any further therapy is approximately 50 % for those with lymph node involvement and 20 ─ 30 % if the lymph nodes are negative. Adjuvant chemotherapy contributes to improved disease-free and overall survival for node-positive (stage III) or high-risk node negative (stage IIB) colon cancer. Similar benefits are observed for adjuvant chemoradiotherapy in rectal cancer. Previous research shows varied rates of adherence to published adjuvant chemotherapy Clinical Practice Guidelines (CPGs) for CRC, although population-based data is scarce. Purpose: The aim of this analysis was to assess adherence rates to adjuvant chemotherapy prescription within 16 weeks of surgery according to local and international CPGs for CRC patients treated with curative intent between 2008 and 2019 at the Uruguayan National Cancer Institute. Data regarding factors associated with chemotherapy receipt beyond 16 weeks from surgery and chemotherapy non receipt was also retrieved and analysed. Methods: We retrospectively reviewed medical and pathology reports of 833 patients diagnosed with CRC at our institution. Patients with stages IIB or III CRC who underwent curative-intent surgery were identified and included in the present analysis. A 16-week benchmark timeline for treatment initiation from date of surgery was considered. Fisher’s exact test was used to determine factors independently associated with receipt of chemotherapy and meeting the 16-week benchmark (p 0.05). Results: A total of 400 patients were identified of which 72% had peritoneal colorectal tumors and 28% had sub-peritoneal rectal tumors. Approximately 70% of the latter group received neoadjuvant chemo-radiotherapy. Considering the total cohort, 61% received adjuvant chemotherapy. Factors predicting chemotherapy receipt in the peritoneal colorectal group were age ≤ 70 and stage III disease. In the sub-peritoneal rectal group no significant effect was found. The 16-week benchmark was met in 72% (175) of those receiving chemotherapy and 70.6% (167) completed 6 months of systemic adjuvant treatment. A total of 156 patients (39%) did not receive adjuvant chemotherapy. The factors predicting chemotherapy non receipt were age > 70 and stage IIB in the peritoneal colorectal group. Conclusions: This analysis of adherence to CPGs identified several factors associated with chemotherapy non receipt and chemotherapy receipt outside of timeline benchmarks from date of curative-intent surgery in Montevideo, Uruguay. The two main factors significantly associated with chemotherapy non receipt were advanced age and lower disease stage. To our knowledge, our data is the first to elucidate these specific factors in the Uruguayan CRC patient population.

scholarly journals Overexpression of TP53 protein is associated with the lack of adjuvant chemotherapy benefit in patients with stage III colorectal cancer

2019 ◽  
Vol 33 (3) ◽  
pp. 483-495
Author(s):  
David S. Williams ◽  
Dmitri Mouradov ◽  
Clare Browne ◽  
Michelle Palmieri ◽  
Meg J. Elliott ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Stage Iii ◽  
Tp53 Protein
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