Comorbidity, age, race and stage at diagnosis in colorectal cancer: a retrospective, parallel analysis of two health systems.
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BACKGROUND: Stage at diagnosis plays a significant role in colorectal cancer (CRC) survival. Understanding which factors contribute to a more advanced stage at diagnosis is vital to improving overall survival. Comorbidity, race, and age are known to impact receipt of cancer therapy and survival, but the relationship of these factors to stage at diagnosis of CRC is less clear. The objective of this study is to investigate how comorbidity, race and age influence stage of CRC diagnosis. METHODS: Two distinct healthcare populations in the United States (US) were retrospectively studied. Using the Cancer Care Outcomes Research and Surveillance Consortium database, we identified CRC patients treated at 15 Veterans Administration (VA) hospitals from 2003-2007. We assessed metastatic CRC patients treated from 2003-2006 at 10 non-VA, fee-for-service (FFS) practices. Stage at diagnosis was dichotomized (non-metastatic, metastatic). Race was dichotomized (white, non-white). Charlson comorbidity index and age at diagnosis were calculated. Associations between stage, comorbidity, race, and age were determined by logistic regression. RESULTS: 342 VA and 340 FFS patients were included. Populations differed by the proportion of patients with metastatic CRC at diagnosis (VA 27% and FFS 77%) reflecting differences in eligibility criteria for inclusion. VA patients were mean (standard deviation; SD) age 67 (11), Charlson index 2.0 (1.0), and were 63% white. FFS patients were mean age 61 (13), Charlson index 1.6 (1.0), and were 73% white. In the VA cohort, higher comorbidity was associated with earlier stage at diagnosis after adjusting for age and race (odds ratio (OR) 0.76, 95% confidence interval (CI) 0.58-1.00; p = 0.045); no such significant relationship was identified in the FFS cohort (OR 1.09, 95% CI 0.82-1.44; p = 0.57). In both cohorts, no association was found between stage at diagnosis and either age or race. CONCLUSION: Higher comorbidity may lead to earlier stage of CRC diagnosis. Multiple factors, perhaps including increased interactions with the healthcare system due to comorbidity, might contribute to this finding. Such increased interactions are seen among patients within a healthcare system like the VA system in the US versus sporadic interactions which may be seen with FFS healthcare.
Continental Population Groups
Delivery of Health Care
Early Detection of Cancer
United States Department of Veterans Affairs
Published Version (Please cite this version)10.1186/1471-2407-8-345
Publication InfoAbbott, DH; Abernethy, Amy Pickar; Grambow, Steven C; Herndon, James Emmett II; Kolimaga, JT; Marcello, JE; ... Zullig, Leah L (2008). Comorbidity, age, race and stage at diagnosis in colorectal cancer: a retrospective, parallel analysis of two health systems. BMC Cancer, 8. pp. 345. 10.1186/1471-2407-8-345. Retrieved from http://hdl.handle.net/10161/16116.
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Adjunct Professor in the Department of Medicine
Amy P. Abernethy, MD PhDDirector, Center for Learning Health Care Director, Duke Cancer Care Research Program Professor of Medicine, Department of Medicine, Division of Medical Oncology, Duke University School of Medicine Associate Professor of Nursing, Duke University School of NursingDr. Abernethy, a hematologist/oncologist and palliative care physician, is Professor of Medicine in the Duke University School of Medicine, Director of the Duke Center for Learn
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
Assistant Professor of Biostatistics and Bioinformatics
I am a collaborative statistical scientist with experience spanning a broad range of clinical research areas, including amyotrophic lateral sclerosis (ALS), post-traumatic stress disorder (PTSD), Prader-Willi syndrome (PWS), prostate cancer, quality of colorectal cancer care, osteoarthritis, lifestyle modification through weight loss, CVD risk reduction through hypertension control, smoking cessation, and substance abuse recovery. I have experience designing and analyzing observational studie
Professor of Biostatistics and Bioinformatics
Current research interests have application to the design and analysis of cancer clinical trials. Specifically, interests include the use of time-dependent covariables within survival models, the design of phase II cancer clinical trials which minimize some of the logistical problems associated with their conduct, and the analysis of longitudinal studies with informative censoring (in particular, quality of life studies of patients with advanced cancer).
Professor of Medicine
Dr. Provenzale is Director of GI Outcomes Research at Duke University and the Director of the Durham Epidemiologic Research and Information Center (ERIC). She directs a research program that integrates observational research, measurement of patient-centered outcomes and decision making to investigate patient-oriented research questions in gastrointestinal cancer screening, surveillance and quality of care. Dr. Provenzale also directs the training program for GI fellows committed to careers
Associate Professor of Medicine
Dr. Zafar is a health services researcher with a focus in improving care delivery for patients with advanced cancer. He has obtained advanced training in health services research and has participated in single-institution, multi-institution and national studies focusing on access to care, cost of care, and comparative effectiveness of care delivery between health systems. His primary area of interest is in the cost of cancer care. He has conducted institutional and national studies on how t
Associate Professor in Population Health Sciences
Leah L. Zullig, PhD, MPH is a health services researcher, Associate Professor in the Duke Department of Population Health Sciences, investigator at the Durham Veterans Affairs Medical Center, and Adjunct Assistant Professor of Health Policy and Management at the University of North Carolina at Chapel Hill. Her research is supported by a VA HSR&D Career Development Award, focused on improving colorectal cancer survivors’ care quality through a self-management intervention bridging ca
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