The impact of socioeconomic status on stage at presentation, receipt of diagnostic imaging, receipt of treatment, and overall survival in colorectal cancer patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10565-10565
Author(s):  
Rajan Shah ◽  
Kelvin K. Chan
Keyword(s):  
Colorectal Cancer ◽  
Socioeconomic Status ◽  
Overall Survival ◽  
Diagnostic Imaging ◽  
Healthcare System ◽  
Universal Healthcare ◽  
Magnetic Resonance Imaging Mri ◽  
Colorectal Cancer Patients ◽  
The Impact ◽  
Universal Healthcare System

10565 Background: Socioeconomic factors have been identified to influence patterns of care in colorectal cancer yet current literature findings are sparse, conflicting, and often incomplete. As such, this study investigates the impact of socioeconomic status (SES) on stage at presentation, receipt of diagnostic imaging, receipt of treatment, and overall survival (OS) in a universal healthcare system. Methods: The Ontario Cancer Registry was accessed to identify a cohort of patients diagnosed with colorectal adenocarcinoma from 2007-2016 in Ontario, Canada. Linkage to administrative datasets allowed study of the impact of SES, measured by mean neighbourhood household income divided into quintiles (Q1-Q5; Q1 = lowest income), on stage, imaging, treatments, and OS. Multivariable regression analyses of all endpoints were adjusted for age, sex, comorbidity, and rurality with OS models also adjusting for imaging and treatment. Results: 39,802 colon and 13,164 rectal patients were identified. Lower SES patients were more likely to present at a higher stage in both cohorts. Lower SES colon patients were less likely to receive magnetic resonance imaging (MRI) of the abdomen, liver resection, adjuvant oxaliplatin, and all palliative systemic therapies studied. In rectal patients, lower SES was associated with decreased receipt of MRI pelvis, rectal cancer resection in early stages, adjuvant oxaliplatin, and most palliative chemotherapies studied. All OS models found that lower SES was associated with poorer OS. Conclusions: These findings suggest disparities across the continuum of cancer care persist even within a universal healthcare system. Further efforts should be directed towards temporal research, identifying barriers, and subsequently applying this information to actionable policies.

Abstract 14: Sex, Gender, Socioeconomic Status and Access to Cardiac Catheterization in the Context of Universal Healthcare Coverage

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Gabriel E Fabreau ◽  
Alexander A Leung ◽  
Danielle A Southern ◽  
John Z Ayanian ◽  
William A Ghali
Keyword(s):  
Socioeconomic Status ◽  
Healthcare System ◽  
Cardiac Catheterization ◽  
Low Income ◽  
Income Quintile ◽  
Sex And Gender ◽  
Clinical Registry ◽  
Time Points ◽  
Universal Healthcare ◽  
Universal Healthcare System

Background: Sex and gender disparities have been described in cardiac care and outcomes following acute coronary syndromes (ACS). Socioeconomic status (SES) may also affect medical care and health outcomes, partly through barriers in access to cardiac catheterization. In Canada, a universal healthcare system may reduce these barriers. We sought to determine whether sex/gender and SES interact to modify the receipt of cardiac catheterization and mortality following an ACS in a universal healthcare system. Methods: Using a provincial multicenter cardiac registry, we assembled a cohort of 14,012 patients admitted with an ACS to any cardiology service in the southern health zones of Alberta, Canada between April 18, 2004 and December 31, 2011 by linking census, vital statistics and clinical registry data. SES was estimated using residential neighbourhood median household income from the 2006 Canadian census. We compared the odds of receiving a cardiac catheterization within 1 and 30 days of admission, and the odds of death within 30 days and 1 year of admission by income quintiles and stratified by sex. Using multivariable logistic regression we controlled for age, geography, cardiac risk factors and clinical comorbidities to estimate the adjusted odds ratios (ORs) of receiving cardiac catheterization and of death. Results: Unadjusted rates of catheterization were higher for men compared to women, with 41% (4048 of 9995) vs. 31% (1237 of 4017) at one day, and 72% (7166 of 9995) vs. 62% (2495 of 4017) at 30 days (p<0.001 for both time points). Further, men had lower mortality rates with 2% (200 of 9995) vs. 2.8% (112 of 4017) at 30 days, and 5.2% (520 of 9995) vs. 7.4% (297 of 4017) at 1 year (p<0.001 for both time points). In models adjusting for SES, women were less likely to receive cardiac catheterization within 1 day (OR 0.79, 95% confidence interval [CI], 0.71 - 0.87) and 30 days (OR 0.73, 95% CI, 0.62-0.86) of admission with an ACS. When examined across SES quintiles, adjusted models revealed differing relationships for men vs. women: each incremental decrease in income quintile was associated with a 7% lower odds of receiving catheterization for women (p=0.005) vs. a smaller 3% decrement in odds for men (p=0.03). Additionally, among women, each decrease in income quintile was associated with a 13% higher odds of 30-day mortality (p=0.02) vs. a 4% higher odds of 30-day mortality for men (p=0.39). Conclusion: The relationships between SES and use of cardiac catheterization and mortality after ACS differ for men vs. women, with women seemingly more vulnerable to the detrimental associations of low income. These findings were present despite a universal healthcare system. This suggests that factors other than insurance status are at play, and that elements of sex and/or gender are effect modifiers. Care protocols designed to improve access to care and outcomes in women, especially low SES women, are required.

scholarly journals Socioeconomic Status and Kidney Transplant Outcomes in a Universal Healthcare System

2019 ◽  
Vol 103 (5) ◽  
pp. 1024-1035 ◽  
Author(s):  
Kyla L. Naylor ◽  
Gregory A. Knoll ◽  
Salimah Z. Shariff ◽  
Eric McArthur ◽  
Amit X. Garg ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Kidney Transplant ◽  
Healthcare System ◽  
Transplant Outcomes ◽  
Universal Healthcare ◽  
Universal Healthcare System

Wait times for colorectal cancer patients in a universal healthcare system over a decade: Is it sustainable?

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 697-697
Author(s):  
Megan E Delisle ◽  
Ramzi Helewa ◽  
Jason Park ◽  
David J Hochman ◽  
Andrew McKay
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Healthcare System ◽  
Pathological Diagnosis ◽  
Wait Times ◽  
Administrative Claims ◽  
Universal Healthcare ◽  
Time To Diagnosis ◽  
Universal Healthcare System

697 Background: Delays in treatment for colorectal cancer (CRC) may worsen prognosis and increase patient anxiety. This study aims to understand population-based trends and variations in wait times (WTs) for CRC in a universal healthcare system over a decade. Methods: Patients diagnosed with stage I-IV CRC in Manitoba, Canada between 2004 and 2014 were included. Data were obtained through province-wide administrative claims and cancer registry. WTs were defined as time from index contact to pathological diagnosis (diagnosis WT), time from pathological diagnosis to first treatment (treatment WT) and total (diagnosis + treatment WT). Index contact was the consult preceding the first gastrointestinal investigation in the year preceding the date of diagnosis. First treatment was radiation, chemotherapy or surgery. The association between WTs and year of diagnosis was estimated using Negative Binomial regression and reported as incidence rate ratio (IRR). Variability in WTs by year were estimated using the Coefficient of Variation (CV) and average annual percent change (AAPC). A CV > 100 indicates high-variability and < 100 indicates low-variaability. Results: A total of 5359 patients were diagnosed with CRC (1802 rectal vs 3557 colon). WTs increased overall. Total WTs for rectal cancer increased by 6% (IRR 1.06, 95% CI 1.04-1.07, p < 0.01) per year from a median of 90 days in 2004 to 147 days in 2014. This was due increases in time to diagnosis (IRR 1.07, 95% CI 1.06-1.09, p < 0.01) and treatment (IRR 1.04, 95% CI 1.03-1.06, p < 0.01). Total colon cancer WTs increased an estimated 5% (IRR 1.05, 95% CI 1.04-1.06, p < 0.01) per year from a median of 89 days in 2004 to 110 days in 2014. This was due to both time to diagnosis (IRR 1.05, 95% CI 1.04-1.07, p < 0.01) and treatment (IRR 1.03, 95% CI 1.02-1.04, p < 0.01). There was increasing variability in total WTs. The CV increased from 87 in 2004 to 102 in 2014 in rectal cancer (AAPC +3.85%) and from 86 in 2004 to 128 in 2014 in colon cancer (AAPC + 5.04%). Conclusions: Total WTs for CRC in Manitoba have increased from 2004 and 2014. This may reflect the growing challenges in providing increasingly complex cancer care to geographically dispersed populations in a universal healthcare system.

Overall survival of elderly metastatic colorectal cancer patients treated in second and third line by tumor site.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 742-742
Author(s):  
Patricia Luhn ◽  
Edward Cha ◽  
Angela Fu-Chi Hsieh ◽  
Michael Taylor ◽  
William Grossman
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Metastatic Colorectal Cancer ◽  
Cancer Patients ◽  
Stage Iv ◽  
Stage Iv Colorectal Cancer ◽  
First Line Therapy ◽  
Third Line ◽  
Colorectal Cancer Patients ◽  
The Impact

742 Background: The anatomical side of the colon where a tumor arises has been shown to be prognostic in patients treated with first-line therapy; patients with tumors that arise from the left side of the colon have significantly longer survival compared with patients whose tumors arise from the right side of the colon. However, there is little evidence of whether this factor is prognostic in later lines of treatment. The objective of this study was to determine the impact of tumor side on the survival of metastatic colorectal cancer patients who received second line (2L) or third line (3L) therapy. Methods: Metastatic (stage IV) colorectal cancer patients in the Surveillance, Epidemiology, and End Results (SEER) database linked to Medicare claims diagnosed 2001-2005 who received 2L (n = 921) or 3L (n = 502) therapy were included in the study. Overall survival (OS) was determined from the start of the indicated line of therapy and was estimated using the Kaplan-Meier method; statistical differences were tested using the log-rank tests. Results: The distribution of tumor sites was similar for 2L and 3L treated patients (right: 36%; left: 58%; transverse: 6%; for 2L). The median follow up time from start of therapy was 11 months (mo) for 2L and 10 mo for 3L patients. Median OS for left-sided tumors receiving 2L+ therapy was 13.6 mo (95%CI: 11.9, 14.8) compared with 8.7 mo (95%CI: 7.5, 9.9) for right-sided tumors (log-rank p < 0.001). Similar results were seen in patients receiving 3L+ therapy, although the difference was of lesser magnitude. The median OS for patients with left-sided tumors was 10.8 mo (95%CI: 9.6, 12.9) compared with 7.6 mo (95%CI: 5.7, 9.4) for right-sided tumors (log-rank p = 0.002). Conclusions: These results suggest that side of tumor origin remains a prognostic factor for colorectal cancer patients treated in later lines of therapy (2L+).

scholarly journals Liver Immune Microenvironment and Metastasis from Colorectal Cancer-Pathogenesis and Therapeutic Perspectives

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2418
Author(s):  
Xuezhen Zeng ◽  
Simon E. Ward ◽  
Jingying Zhou ◽  
Alfred S. L. Cheng
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastasis ◽  
Cancer Patients ◽  
High Recurrence Rate ◽  
Immune Microenvironment ◽  
Liver Sinusoidal Endothelial Cells ◽  
Premetastatic Niche ◽  
Cancer Pathogenesis ◽  
Colorectal Cancer Patients ◽  
The Impact

A drastic difference exists between the 5-year survival rates of colorectal cancer patients with localized cancer and distal organ metastasis. The liver is the most favorable organ for cancer metastases from the colorectum. Beyond the liver-colon anatomic relationship, emerging evidence highlights the impact of liver immune microenvironment on colorectal liver metastasis. Prior to cancer cell dissemination, hepatocytes secrete multiple factors to recruit or activate immune cells and stromal cells in the liver to form a favorable premetastatic niche. The liver-resident cells including Kupffer cells, hepatic stellate cells, and liver-sinusoidal endothelial cells are co-opted by the recruited cells, such as myeloid-derived suppressor cells and tumor-associated macrophages, to establish an immunosuppressive liver microenvironment suitable for tumor cell colonization and outgrowth. Current treatments including radical surgery, systemic therapy, and localized therapy have only achieved good clinical outcomes in a minority of colorectal cancer patients with liver metastasis, which is further hampered by high recurrence rate. Better understanding of the mechanisms governing the metastasis-prone liver immune microenvironment should open new immuno-oncology avenues for liver metastasis intervention.

Sign in / Sign up

Export Citation Format

Share Document