Changes in the proportion of patients presenting with early stage colon cancer over time among Medicaid expansion and nonexpansion states.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 251-251
Author(s):  
Scarlett Hao ◽  
Rebecca A Snyder ◽  
William Irish ◽  
Alexander A. Parikh
Keyword(s):  
Colon Cancer ◽  
Early Stage ◽  
Population Based ◽  
Absolute Difference ◽  
Study Cohort ◽  
Median Income ◽  
Medicaid Expansion ◽  
High School Degree ◽  
Early Stage Colon Cancer ◽  
Over Time

251 Background: In 2010, the Affordable Care Act required insurance plans to cover preventative screening, and the Medicaid expansion provision enabled participating states to increase Medicaid coverage of uninsured individuals. The aim of this study was to determine whether the proportion of patients diagnosed with early vs. late stage colon cancer (CC) at Commission on Cancer (CoC) facilities differed over time within states that expanded Medicaid in January 2014 (MES) vs. non-Medicaid expansion states (NMES). Methods: A hospital-based cohort study of patients diagnosed with CC from 2006-2016 was performed using the National Cancer Database. Uninsured and Medicaid-insured patients in MES were compared with patients in NMES. Patients with Medicare, private, or government insurance were excluded. The observed proportions of patients with early (AJCC I-II) vs late (III-IV) stage within each cohort were compared over time. Propensity score adjusted probability of early stage at presentation was determined among patients residing in MES and NMES. Results: The study cohort included 10,289 patients in MES and 15,173 patients in NMES. Compared to MES, a greater proportion of patients in NMES were black (33.4% vs 24.0%), had a median income < $38,000 (39.7% vs 28.2%), and resided in a state with ≥21% of the population without a high school degree (37.4% vs 28.1%). The proportions of early stage CC in both cohorts in 2006 were similar. In NMES, this proportion remained constant over time until 2014 and declined by 0.8% per year after 2014. Within MES, the proportion of early stage CC increased by 0.6% per year until 2014 and 0.9% per year after 2014. By 2016, the absolute difference in the propensity adjusted proportion of early stage CC between cohorts was 8.8% (39.7% vs 30.9%, p < 0.001). Conclusions: Following Medicaid expansion in 2014, the proportion of patients presenting to a CoC facility with early stage CC increased over time within MES and declined in NMES. Further investigation, including population-based research, is warranted to determine if enrollment in Medicaid improves access to colorectal cancer screening and leads to earlier stage at diagnosis.

Gender differences in outcomes for early-stage colon cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 605-605 ◽  
Author(s):  
Sina Alipour ◽  
Hagen F. Kennecke ◽  
Howard John Lim ◽  
Winson Y. Cheung
Keyword(s):  
Gender Differences ◽  
Colon Cancer ◽  
Survival Rate ◽  
Cox Regression ◽  
Early Stage ◽  
Population Based ◽  
Stage Ii ◽  
Cancer Specific Survival ◽  
Interaction Terms ◽  
Early Stage Colon Cancer

605 Background: Retrospective analyses of clinical trials suggest that gender may influence the risk of recurrence and survival in patients diagnosed with early stage colon cancer. Whether this association persists in the setting of routine clinical practice is unclear. Our aims were to 1) assess for gender differences in outcomes in early stage colon cancer and 2) evaluate if the effect of gender on outcomes is modified by adjuvant therapy (AT). Methods: Using a population-based cohort of patients diagnosed with stage II or III colon cancer and referred to any 1 of 5 regional cancer centers in British Columbia, Canada from 2001 to 2005, we compared 5-year outcomes between men and women. Multivariate Cox proportional hazard models were constructed to explore the relationships between gender and prognosis, while controlling for patient and tumor characteristics. Interaction terms between gender and AT were used to examine the predictive value of gender. Results: We included 1837 patients: 970 men and 867 women. Baseline characteristics were similar: median ages were 68 and 69 years; 39 and 38% had stage II colon cancer; and 46 and 44% received AT, respectively. Outcomes were better in women than in men (5-year cancer-specific survival rate 73 vs. 71% and 5-year overall survival rate 68 vs. 62%). In Cox regression models, women continue to experience better overall prognosis (HR for death = 0.80, 95% CI 0.69-0.92, p=0.003) when compared to men. Advanced age, stage III disease, and lack of AT also correlated with worse outcomes (all p<0.01). The effect of gender on outcomes remained similar regardless of AT (HR 0.86 among women with AT and HR 0.75 among women without AT, interaction p=0.35). Conclusions: Gender is a prognostic, but not a predictive, factor for this cohort of patients with early stage colon cancer. Studies to investigate the biological mechanisms underlying this gender difference in outcomes are warranted.

Prognostic impact of tumour laterality in early-stage colon cancer: A population-based study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15148-e15148
Author(s):  
Safiya Karim ◽  
Kelly Brennan ◽  
Sulaiman Nanji ◽  
Scott R. Berry ◽  
Christopher M. Booth
Keyword(s):  
Colon Cancer ◽  
Early Stage ◽  
Population Based ◽  
Stage Iii ◽  
Disease Stage ◽  
Prognostic Impact ◽  
Term Survival ◽  
Long Term Survival ◽  
Early Stage Colon Cancer

e15148 Background: Recent data has suggested that disease biology and outcome of colon cancer may differ between right-sided and left-sided tumours. Here we explore differences in laterality based on disease characteristics and outcomes in a population-based cohort of early-stage colon cancer. Methods: Electronic records of treatment were linked to the Ontario Cancer Registry to identify all patients with colon cancer in 2002-2008. The study population included a 25% random sample of all patients with resected stage 0-III disease. Right-sided colon cancer was defined as any tumor arising in the cecum, ascending colon, hepatic flexure or transverse colon. Left-sided colon cancer was defined as any tumor arising from the splenic flexure, descending colon, sigmoid colon or rectosigmoid colon. Log binomial regression was used to identify factors associated with laterality. Cox models were used to explore the association between laterality and overall (OS) and cancer-specific (CSS) survival. Results: Among the study cohort (n = 6391) median age was 72 and 52% (3307/6391) had right-sided disease. Stage distribution was 2% (98/6391) stage 0, 17% (1091/6391) stage I, 38% (2446/6391) stage II, and 43% (2756/6391) stage III. Patients with right-sided colon cancer were more likely to be older (p < 0.001), female (p < 0.001) and have greater co-morbidity (p = 0.001). Right-sided cancer was more likely to be T4 (19% vs 16%, p = 0.001) and poorly differentiated (21% vs 10%, p < 0.001) but less likely to be node positive (42% vs 45%, p = 0.029) compared to left-sided disease. In adjusted analyses there was no difference in long-term survival for right-sided compared to left-sided colon cancer: OS HR 1.00 (95%CI, 0.92-1.08); CSS HR 1.00 (0.91-1.10). These results were consistent when the survival analyses were restricted to stage III disease: OS HR 1.03 (95%CI 0.93-1.14); CSS HR 1.10 (0.97-1.24). Conclusions: In this population-based cohort of early-stage resected colon cancer disease laterality was not associated with long-term survival.

scholarly journals Age-related inequalities in colon cancer treatment persist over time: a population-based analysis

2018 ◽  
Vol 73 (1) ◽  
pp. 34-41 ◽  
Author(s):  
Louise Hayes ◽  
Lynne Forrest ◽  
Jean Adams ◽  
Mira Hidajat ◽  
Yoav Ben-Shlomo ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Cancer Treatment ◽  
Treatment Decision ◽  
Population Based ◽  
Surgical Patients ◽  
Area Deprivation ◽  
Treatment Decision Making ◽  
Colon Cancers ◽  
Age Related ◽  
Over Time

BackgroundOlder people experience poorer outcomes from colon cancer. We examined if treatment for colon cancer was related to age and if inequalities changed over time.MethodsData from the UK population-based Northern and Yorkshire Cancer Registry on 31 910 incident colon cancers (ICD10 C18) diagnosed between 1999–2010 were obtained. Likelihood of receipt of: (1) cancer-directed surgery, (2) chemotherapy in surgical patients, (3) chemotherapy in non-surgical patients by age, adjusting for sex, area deprivation, cancer stage, comorbidity and period of diagnosis, was examined.ResultsAge-related inequalities in treatment exist after adjustment for confounding factors. Patients aged 60– 69, 70–79 and 80+ years were significantly less likely to receive surgery than those aged <60 years (multivariable ORs (95% CI) 0.84(0.74 to 0.95), 0.54(0.48 to 0.61) and 0.19(0.17 to 0.21), respectively). Age-related differences in receipt of surgery and adjuvant chemotherapy (but not chemotherapy in non-surgical patients) narrowed over time for the ’younger old’ (aged <80 years) but did not diminish for the oldest patients.ConclusionsAge inequality in treatment of colon cancer remains after adjustment for confounders, suggesting age remains a major factor in treatment decisions. Research is needed to better understand the cancer treatment decision-making process, and how to influence this, for older patients.

scholarly journals Nivolumab, ipilimumab and COX2-inhibition in early stage colon cancer

2017 ◽  
Vol 28 ◽  
pp. v207
Author(s):  
M. Chalabi ◽  
M. Van Leerdam ◽  
A. Aalbers ◽  
J. Van den Berg ◽  
G. Beets ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Early Stage ◽  
Early Stage Colon Cancer

scholarly journals Early stage colon cancer

2013 ◽  
Vol 19 (46) ◽  
pp. 8468 ◽  
Author(s):  
Hugh James Freeman
Keyword(s):  
Colon Cancer ◽  
Early Stage ◽  
Early Stage Colon Cancer

scholarly journals The Predictive and Prognostic Value of Sex in Early-Stage Colon Cancer: A Pooled Analysis of 33,345 Patients from the ACCENT Database

2013 ◽  
Vol 12 (3) ◽  
pp. 179-187 ◽  
Author(s):  
Winson Y. Cheung ◽  
Qian Shi ◽  
Michael O'Connell ◽  
James Cassidy ◽  
Charles D. Blanke ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Prognostic Value ◽  
Early Stage ◽  
Pooled Analysis ◽  
Early Stage Colon Cancer ◽  
Predictive And Prognostic Value

scholarly journals Simultaneous Assessment of the Efficacy and Toxicity of Marine Mollusc–Derived Brominated Indoles in an In Vivo Model for Early Stage Colon Cancer

2017 ◽  
Vol 17 (2) ◽  
pp. 248-262 ◽  
Author(s):  
Babak Esmaeelian ◽  
Kirsten Benkendorff ◽  
Richard K. Le Leu ◽  
Catherine A. Abbott
Keyword(s):  
Colon Cancer ◽  
Natural Products ◽  
Liver Toxicity ◽  
Early Stage ◽  
Blood Biochemistry ◽  
In Vivo Model ◽  
Liver Histopathology ◽  
Genotoxic Carcinogens ◽  
Early Stage Colon Cancer

The acute apoptotic response to genotoxic carcinogens animal model has been extensively used to assess the ability of drugs and natural products like dietary components to promote apoptosis in the colon and protect against colorectal cancer (CRC). This work aimed to use this model to identify the main chemopreventative agent in extracts from an Australian mollusc Dicathais orbita, while simultaneously providing information on their potential in vivo toxicity. After 2 weeks of daily oral gavage with bioactive extracts and purified brominated indoles, mice were injected with the chemical carcinogen azoxymethane (AOM; 10 mg/kg) and then killed 6 hours later. Efficacy was evaluated using immunohistochemical and hematoxylin staining, and toxicity was assessed via hematology, blood biochemistry, and liver histopathology. Comparison of saline- and AOM-injected controls revealed that potential toxic side effects can be interpreted from blood biochemistry and hematology using this short-term model, although AOM negatively affected the ability to detect histopathological effects in the liver. Purified 6-bromoisatin was identified as the main cancer preventive agent in the Muricidae extract, significantly enhancing apoptosis and reducing cell proliferation in the colonic crypts at 0.05 mg/g. There was no evidence of liver toxicity associated with 6-bromoisatin, whereas 0.1 mg/g of the brominated indole tyrindoleninone led to elevated aspartate aminotransferase levels and a reduction in red blood cells. As tyrindoleninone is converted to 6-bromoisatin by oxidation, this information will assist in the optimization and quality control of a chemopreventative nutraceutical from Muricidae. In conclusion, preliminary data on in vivo safety can be simultaneously collected when testing the efficacy of new natural products, such as 6-bromoisatin from Muricidae molluscs for early stage prevention of colon cancer.

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