Effect of dementia diagnosis on receipt of postoperative colon cancer chemotherapy.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 769-769
Author(s):  
Yingjia Chen ◽  
Thomas John Semrad ◽  
Rosemary Donaldson Cress ◽  
Laurel A. Beckett
Keyword(s):  
Colon Cancer ◽  
Cancer Chemotherapy ◽  
Stage Iii ◽  
Dementia Diagnosis ◽  
Part D ◽  
Disease Characteristics ◽  
Home Health Agencies ◽  
Medicare Patients ◽  
Combined Algorithm ◽  
To Receive

769 Background: Colon cancer and dementia have a high risk of co-occurrence. Prior studies found that patients with dementia have higher mortality than non-demented counterparts, mostly from non-cancer causes. We hypothesized that a dementia diagnosis using an improved algorithm would be associated with reduced use of postoperative therapy. Methods: In addition to the claims-based algorithm for dementia published by Centers for Medicare and Medicaid Services that uses SEER-Medicare Medicare Provider Analysis and Review, Carrier Claims, Home Health Agencies, and Outpatient files, we developed a medication-based algorithm using the part D file based on prescription for any of the five FDA-approved dementia drugs (donepezil, galantamine, memantine, rivastigmine, tacrine). We measured agreement between the two diagnostic algorithms with k-statistics. Using each algorithm and a final combined algorithm, we used multivariable logistic regression adjusting for demographics and disease characteristics to examine the effect of dementia on the use of post-operative colon cancer chemotherapy. Parallel analyses restricted the population to later-stage cancer patients (stage III/IV). Results: 46,126 patients diagnosed between 2007 and 2009 were identified. 20% had dementia by either of the algorithms. 9% of the dementia cases were identified through Part D data. The two algorithms showed moderate agreement (k>0.49, p=0.007). After surgery, those patients with dementia by the combined algorithm were less likely to receive chemotherapy (OR = 0.641, 95% CI: 0.597-0.688). Those with dementia identified by part D data were even less likely to receive chemotherapy than those identified by the claims algorithm (OR=0.617, 95% CI: 0.466-0.816 for medication; OR=0.767, 95% CI: 0.684-0.860 for claims). A similar pattern was detected when restricting to stage III/IV patients (OR=0.667, 95% CI: 0.457-0.973). Conclusions: Part D data increases the sensitivity for identifying dementia cases in SEER-Medicare. Patients with dementia are significantly less likely to receive post-operative chemotherapy. Thus, reduced postoperative colon cancer therapy among patients with dementia may contribute to higher cancer-related mortality.

Understanding differences in the receipt of chemotherapy between African-American (AA) and white (W) patients with stage III colon cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6568-6568
Author(s):  
B. N. Polite ◽  
B. Huskey ◽  
M. McKee ◽  
J. J. Dignam
Keyword(s):  
Colon Cancer ◽  
Tumor Location ◽  
Stage Iii ◽  
Future Research ◽  
Insurance Status ◽  
University Of Chicago ◽  
Stage Iii Colon Cancer ◽  
The Difference ◽  
The University ◽  
To Receive

6568 Background: Even when stage is controlled for, AA are more likely to die from colon cancer than are W. Previous research suggests that AA are less likely to receive adjuvant chemotherapy for Stage III colon cancer than W. This study examines the differences in the receipt of chemotherapy for stage III colon cancer and the reasons behind those differences. Methods: The records of patients diagnosed with and/or receiving their first-course of treatment for Stage III colon cancer at the University of Chicago between 1995–2004 were examined. Specifically, patient charts were audited to determine whether the patients had received chemotherapy, and if not, the documented reasons for the non-receipt of therapy. In the case of incomplete records, the patients’ outside physicians were contacted to ascertain the chemotherapy history. Chemotherapy information was unavailable for only 13 patients (5 AA and 8 W). Results: A total of 186 patients (110 AA and 76 W) were diagnosed with stage III colon cancer at the University of Chicago between 1995–2004. No significant differences were seen with respect to age, sex or tumor location between AA and W. In total, 65% of AA versus 82% of W received chemotherapy (OR 0.43; 95% CI: 0.20–0.86). AA were more likely to not undergo chemotherapy because of comorbidities (OR 3.80; 95%CI 1.35–10.50). Those pts not receiving therapy because of comorbidities had a poorer overall survival than those who received therapy (HR 5.9; 95%CI 3.4–10.3). This effect held for both AA and W pts (p=0.65 for race and comorbidity interaction). Among the 146 pts (86AA, 63W) for whom it is known that chemotherapy was recommended, AA were over 9 times as likely to have a documented refusal (OR 9.5; 95% CI 1.19–75.4). These findings were robust to adjustments for age, sex, insurance status and marital status. Conclusions: AA were significantly less likely than W to receive chemotherapy for stage III colon cancer. The reasons for the difference include both refusal of therapy and the presence of comorbidities that the treating physicians felt were a contraindication to therapy. Future research should be directed at better understanding the reasons behind the higher refusal rates for AA patients. No significant financial relationships to disclose.

Choice of therapy and time to first treatment for patients with colon cancer: A National Cancer Database analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14642-e14642
Author(s):  
David C. Olson ◽  
Khaled Mohamed Abou El-Ezz ◽  
Peter T. Silberstein
Keyword(s):  
Colon Cancer ◽  
Stage Iv ◽  
Standard Of Care ◽  
Insurance Status ◽  
National Cancer Database ◽  
Veteran Affairs ◽  
Treatment Data ◽  
Medicare Patients ◽  
Time To First Treatment ◽  
To Receive

e14642 Background: Insurance status has been shown to affect adherence to guidelines in the treatment of colon cancer1. This study aims to investigate trends in management of colon cancer and time to first treatment in patients with various insurance types using the National Cancer Database (NCDB). Methods: Treatment data for 845,121 patients and time to first treatment data for 497,993 patients diagnosed with colon cancer between 2000 and 2010 were identified using the NCDB. Reported utilization of treatment and time to first treatment were analyzed by insurance status. Results: Among all stages of colon cancer, no treatment was received more often by Veteran Affairs (10.5%) and Medicare (10.9%) patients than uninsured (8.8%), managed care (4.5%), private insurance (4.7%), Medicaid (8.4%) or Medicare with supplement (7.7%). Among stage I colon cancer, surgery was received less often by uninsured (90.9%) than other insurance types. Stage III colon cancer patients enrolled in Medicare with/without supplement received chemotherapy less often than other insurance types (49.9% and 46%). Stage IV Medicare patients with/without supplement also received chemotherapy less than other insurance types (59.5% and 52.9%). Surgery as monotherapy was the most common treatment received among all insurance types and stages. More uninsured patients received treatment within 3 days than any other insurance types (61%). A delay of at least 17days occurred more in Veteran Affairs patients than other insurance types (40.6%). Conclusions: This is the largest study to date to have examined treatment trends and time to first treatment. Among all insurance types, Medicare without supplement and Veteran Affairs patients were most likely to receive no treatment. Uninsured were less likely to receive the standard of care treatment with stage I cancers. Medicare patients were less likely to receive the standard of care for stage III and stage IV cancers than other insurance types. Veteran Affairs patients had treatment delayed significantly more than other insurance types. Future studies are needed to assess factors leading to receipt of substandard care.

Predictors of adjuvant chemotherapy (AT) decision-making in referred patients (pts) with stage II and III colon cancer (CC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15070-e15070
Author(s):  
D. S. Ksienski ◽  
M. Levesque ◽  
S. Gill
Keyword(s):  
Decision Making ◽  
Colon Cancer ◽  
High Risk ◽  
Marital Status ◽  
Univariate Analysis ◽  
Stage Ii ◽  
Stage Iii ◽  
Low Grade ◽  
Delayed Presentation ◽  
To Receive

e15070 Background: Randomized clinical trials have demonstrated a robust survival benefit of AT for node positive (stage III) CC patients; similar evidence for node-negative (stage II) patients is lacking. While guidelines recommend AT for stage III colon cancer but AT is not a routine recommendation for stage II. Actual practice of the evidence varies and suggests the interplay of additional variables. We sought to identify factors associated with practice patterns which vary from conventional AT guidelines, ie no AT in stage III CC and receipt of AT in.stage II CC. Methods: Data pertaining to pt demographics, tumor characteristics, and treatment for pts with resected stage II (n=176) and III CC (n=235) referred to the British Columbia Cancer Agency in 2004 was collected by retrospective chart review. One-sided Fisher's exact test was used to assess statistical significance (p<0.05) by univariate analysis. Results: 28% (n=49) of stage II pts received AT. Compared to untreated pts, stage II pts who received AT were significantly more often younger than 66 years (57% vs 21%), lived in a city with a regional cancer center (71% vs 51%), had T4 disease (33% vs 9%), vascular invasion (22% vs 5%), perineural invasion (10% vs 2%) and high grade (26% vs 2%). Marital status, ethnicity, lymphatic invasion and high CEA were not associated with AT in stage II. 29% (n=69) of stage III pts did not receive AT. Compared to treated pts, stage III pts who did not receive AT were significantly more often older than 65 years (91% vs 51%), had low grade disease (96% vs 84%) and presented for oncology consultation greater than 42 days from surgery (29% vs 11%). Marital status, ethnicity, residence, T4 status or N2 status were not associated with no AT in stage III. Conclusions: For pts with stage II CC, subgroups associated with high risk for relapse were more likely to receive AT although the majority of stage II pts in this cohort remained untreated. For stage III disease, almost one-third of referred pts did not receive AT. Older age and delayed presentation were strongly associated with failure to receive AT. Within the limitations of a retrospective review, these data highlight the significant and commonly observed implications of factors other than stage in AT decision-making for high risk resected CC. No significant financial relationships to disclose.

scholarly journals Calendar time-specific propensity scores and comparative effectiveness research for stage III colon cancer chemotherapy

2013 ◽  
Vol 22 (8) ◽  
pp. 810-818 ◽  
Author(s):  
Christina DeFilippo Mack ◽  
Robert J. Glynn ◽  
M. Alan Brookhart ◽  
William R. Carpenter ◽  
Anne Marie Meyer ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Cancer Chemotherapy ◽  
Comparative Effectiveness Research ◽  
Comparative Effectiveness ◽  
Propensity Scores ◽  
Stage Iii ◽  
Effectiveness Research ◽  
Calendar Time ◽  
Stage Iii Colon Cancer ◽  
Time Specific

scholarly journals Re: Completion of Therapy by Medicare Patients With Stage III Colon Cancer

2006 ◽  
Vol 98 (21) ◽  
pp. 1582-1582 ◽  
Author(s):  
Peter Gibbs ◽  
Stephen McLaughlin ◽  
Iain Skinner ◽  
Ian Jones ◽  
Ian Hayes ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Stage Iii ◽  
Stage Iii Colon Cancer ◽  
Medicare Patients

Reasons for and outcomes of adjuvant chemotherapy choices in elderly patients with resected stage III colon cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 571-571 ◽  
Author(s):  
Jenny Ko ◽  
Hagen F. Kennecke ◽  
Howard John Lim ◽  
Sharlene Gill ◽  
Ryan Woods ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Treatment Effect ◽  
Advanced Age ◽  
Stage Iii ◽  
Stage Iii Colon Cancer ◽  
To Receive

571 Background: Research suggests that elderly cancer patients are commonly undertreated, but the precise reasons for this are unclear. Robust clinical data on the optimal adjuvant chemotherapy regimen for elderly colon cancer patients are also lacking. Our aims were to: 1) evaluate the impact of advanced age on choice of adjuvant chemotherapy (none vs. capecitabine vs. FOLFOX) for curatively resected colon cancer; b) determine the reasons for selecting a particular regimen; and 3) examine whether treatment effect on outcomes is modified by age. Methods: All patients diagnosed with stage III colon cancer between 2006 and 2008, and referred to any 1 of 5 regional cancer centers in British Columbia, Canada were identified. Descriptive statistics were used to summarize treatment patterns among young patients (YPs) aged <70 years vs. elderly patients (EPs) aged >/=70 years. Multivariate logistic regression models were constructed to evaluate the association between adjuvant chemotherapy and cancer-specific survival (CSS) in YPs and EPs. Results: In total, 810 patients were identified: 51% were male, 52% YPs and 48% EPs, and 74% received adjuvant chemotherapy. When compared to YPs, EPs had worse ECOG and more comorbidities (both p<0.001). EPs were less likely than YPs to receive adjuvant chemotherapy (57% vs. 91%, p<0.001). Frequent reasons for no treatment included age, comorbidities, and small perceived benefit from adjuvant therapy. Among treated pts, EPs were less likely to receive FOLFOX (32% vs. 74%, p<0.0001) in favor of capecitabine due to patient preference, age, and comorbidities. In multivariate analyses, receipt of either FOLFOX or capecitabine was correlated with improved CSS compared to surgery alone. The effect of adjuvant chemotherapy on CSS was not modified by age (interaction p for capecitabine and age = 0.26; interaction p for FOLFOX and age = 0.40). Conclusions: EPs with stage III colon cancer frequently received either no adjuvant treatment or capecitabine monotherapy due to advanced age and co-morbidities. The treatment effect of adjuvant therapy on CSS is similar among EPs and YPs. Adjuvant chemotherapy should not be withheld from colon cancer patients based on advanced age alone.

Treatment trends for stage III non-small cell lung cancer for noninsured patients compared with other types of insurances: A National Cancer Database analysis.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 262-262
Author(s):  
Khaled Abou El Ezz ◽  
David Charles Olson ◽  
Peter T. Silberstein
Keyword(s):  
Stage Iii ◽  
Insurance Status ◽  
National Cancer Database ◽  
Database Analysis ◽  
Medicare Patients ◽  
Stage Iii Nsclc ◽  
Insured Patients ◽  
Treatment Trends ◽  
To Receive ◽  
Privately Insured

262 Background: This study investigated trends in management of stage III NSCLC in patients with no insurance versus other insurance types using the National Cancer Database (NCDB). Methods: 281,277 patients with Stage III NSCLC were identified from 2000 to 2009 using the NCDB. Reported use of surgery, radiation, chemotherapy, or no treatment were analyzed by insurance status. Results: Radiation/chemotherapy was most often used to treat stage III NSCLC among non-insured (41.7%), Medicare (31.3%), Medicaid (42.3%), and private insured patients (43.9%). Non-insured were just as likely to receive radiation/chemotherapy as Medicaid (41.7% vs. 42.3%, p=0.36) but less likely than privately insured (41.7% vs. 43.9%, p<0.001). Non-insured were more likely to receive no treatment than privately insured (20.8% vs. 11.7%, p<0.001) and Medicaid (20.8% vs. 16.8%, p <0.001) but less likely than Medicare (20. 8% vs. 24.6%, p<0.001). Tri-modality treatment was given less often to non-insured patients than privately insured (4.6% vs. 10.2%, p<0.001) and Medicaid (4.6% vs. 6.2%, p<0.001) but more often than Medicare patients (4.6% vs. 3.7%, p<0.001). Conclusions: Stage III NSCLC was most often given chemotherapy/radiation regardless of insurance status. Non-insured patients received this treatment as often as Medicaid but less often than privately insured. Non-insured patients also received no treatment more often than Medicaid and privately insured and less often than Medicare. Future studies could examine if average age among the populations impacted these findings. [Table: see text]

Patterns of care among veterans with colon cancer: Insights from California SEER, Medicare and VA-linked data

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6586-6586
Author(s):  
D. M. Hynes ◽  
E. Tarlov ◽  
R. Perrin ◽  
Q. Zhang ◽  
C. Bennett ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Registry ◽  
Stage Iv ◽  
Stage Iii ◽  
National Study ◽  
P Value ◽  
One Year ◽  
Pattern Information ◽  
To Receive

6586 Background: U.S. veterans have been shown to be a vulnerable population with high cancer rates, yet practice pattern information is lacking. Linkage of cancer registry, Medicare, and VA data provides a more complete view of health status and healthcare received among veterans with cancer. Methods: As part of a national study, a retrospective cohort of incident colon cancer patients from the California Cancer Registry data, who were = 66 years old and eligible to use VA and Medicare between 1999 and 2001, were followed for three years through 2004. We examined practice patterns for stages I-IV colon cancer, specifically, surgery and use of chemotherapy, and trends in one-year mortality using descriptive and multivariate regression models. Results: Among 633 veterans with colon cancer, 93% were male; 16% were African American; 28% were diagnosed at a VA facility compared to 72% at a Medicare facility, and 553 (87%) had colectomy. One year mortality rate was 29%. Among the 553 colectomy patients, prevalence of chemotherapy use, according to stage was 8%, 27%, 61% and 52% for stages I-IV, respectively (p-value <0.0001). Regression analyses of factors affecting whether chemotherapy was received revealed that Stage III patients were most likely to receive adjuvant chemotherapy (Odds Ratio (OR) 19.80, 95% Confidence Interval (CI): 9.68–40.50). However stage II and stage IV patients were also highly likely to receive chemotherapy following surgery (OR: 4.41 CI: 2.18–8.91 and OR: 13.21; CI: 6.01–29, respectively). Patients =76 years and those =86 years were less likely to receive chemotherapy following surgery (OR: 0.61, CI: 0.40–0.94 and OR: 0.25, CI: 0.094–0.64, respectively) compared to patients 66–75 years. Patients with Charlson Comorbidity Score of 2 or greater were less likely to receive chemotherapy (OR: 0.49; CI: 0.29–0.84). Treating facility (VA or Medicare), did not affect chemotherapy use. Conclusions: Among veterans with colon cancer in California, older patients were less likely to receive chemotherapy even when stage and comorbidity status were considered. Efforts focused on improving guideline consistent adjuvant chemotherapy use among older veterans with stage III colon cancer across treating facilities may yield the greatest benefit. No significant financial relationships to disclose.

Preplanned initial safety analysis of ACTS-CC 02 trial: A large randomized phase III trial of SOX versus UFT/LV as adjuvant chemotherapy for high-risk stage III colon cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 572-572 ◽  
Author(s):  
Hiroya Takiuchi ◽  
Naohiro Tomita ◽  
Narikazu Boku ◽  
Toshiaki Watanabe ◽  
Kenjiro Kotake ◽  
...  
Keyword(s):  
Colon Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Adverse Events ◽  
Curative Resection ◽  
Phase Iii ◽  
Stage Iii ◽  
Postoperative Adjuvant Chemotherapy ◽  
Stage Iii Colon Cancer ◽  
To Receive

572 Background: The ACTS-CC 02 trial is designed to verify the superiority of postoperative adjuvant chemotherapy of S-1/Oxaliplatin (SOX) for patients with anyT, N2 colon cancer compared with UFT/Leucovorin (UFT/LV), which is one of standard adjuvant chemotherapies in Japan. To date, there have been no reported phase III trials evaluating SOX as postoperative adjuvant chemotherapy. This report presents initial safety data obtained from 50 patients who received SOX in the trial. Methods: Patients who underwent curative resection for anyT, N2 colon cancer were randomly assigned to receive either SOX (100 mg/m2 of oxaliplatin on day1, and 80 to 120 mg/day according to body surface area (BSA) of S-1 on days 1-14, every 21 days, 8 courses) or UFT/LV (300 to 600 mg/day according to BSA of UFT and 75 mg/day of LV on days 1-28, every 35 days, 5 courses). Data were collected from initial consecutive 50 patients assigned to the SOX group and analyzed when they were considered evaluable for safety as planned in the protocol. This ongoing trial is designed to accrue 1200 patients. As of September 15, 2011, 319 patients have been accrued. Results: Of 50 patients assigned to receive SOX, 48 were evaluable for safety. The median number of treatment courses was 5 (range: 1-8). The relative dose intensity of S-1 was 83.8% and that of oxaliplatin was 86.6%. Grade 3 adverse events were neutropenia (14.6%), thrombocytopenia (2.1%), ALT elevation (2.1%), diarrhea (8.3%), fatigue (2.1%), and peripheral sensory neuropathy (2.1%). Grade 4 adverse effects were not observed. Conclusions: In this initial safety analysis, the incidence and severity of adverse events with SOX were acceptable in patients with high risk stage III colon cancer after curative resection. Enrollment of patients is ongoing.

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