Comorbidity, age, race and stage at diagnosis in colorectal cancer: a retrospective, parallel analysis of two health systems.

Zafar, S Yousuf

Abernethy, Amy P

Abbott, David H

Grambow, Steven C

Marcello, Jennifer E

Herndon, James E

Rowe, Krista L

Kolimaga, Jane T

Zullig, Leah L

Patwardhan, Meenal B

Provenzale, Dawn T

England

2018-03-01T14:27:12Z

2018-03-01T14:27:12Z

2008-11-25

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.

https://www.ncbi.nlm.nih.gov/pubmed/19032772

1471-2407-8-345

1471-2407

https://hdl.handle.net/10161/16116

eng

BMC

BMC Cancer

10.1186/1471-2407-8-345

Age Factors

Aged

Colorectal Neoplasms

Comorbidity

Continental Population Groups

Delivery of Health Care

Early Detection of Cancer

Fee-for-Service Plans

Female

Humans

Male

Middle Aged

Neoplasm Metastasis

Neoplasm Staging

Retrospective Studies

United States

United States Department of Veterans Affairs

Comorbidity, age, race and stage at diagnosis in colorectal cancer: a retrospective, parallel analysis of two health systems.

Journal article

Zafar, S Yousuf|0000-0002-9039-5258

Grambow, Steven C|0000-0001-6037-3253

Zullig, Leah L|0000-0002-6638-409X

https://www.ncbi.nlm.nih.gov/pubmed/19032772

345

Basic Science Departments

Biostatistics & Bioinformatics

Clinical Science Departments

Duke

Duke Cancer Institute

Duke Clinical Research Institute

Duke Global Health Institute

Institutes and Centers

Institutes and Provost's Academic Units

Medicine

Medicine, Gastroenterology

Medicine, General Internal Medicine

Medicine, Medical Oncology

Nursing

Population Health Sciences

Sanford

Sanford School of Public Policy

School of Medicine

School of Nursing

University Institutes and Centers

Published online

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