TY - JOUR
T1 - Age and rural residence effects on accessing colorectal cancer treatments
T2 - A registry study
AU - Sankaranarayanan, Jayashri
AU - Watanabe-Galloway, Shinobu
AU - Sun, Junfeng
AU - Qiu, Fang
AU - Boilesen, Eugene C.
AU - Thorson, Alan G.
N1 - Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2010/4
Y1 - 2010/4
N2 - Objectives: To test the hypotheses that older patients with colorectal cancer (CRC) and rural patients are less likely to undergo surgery, radiation, and chemotherapy. Study Design: Retrospective study. Methods: A total of 6561 patients with CRC between January 1998 and December 2003 were identified by incident International Classification of Diseases for Oncology codes from the Nebraska Cancer Registry. In multivariate logistic regression analyses, we studied the association of age and residence county (rural vs urban and micropolitan) with each of 3 CRC treatments by anatomic site. Results: After adjusting for patient demographics, insurance payer, ratio of providers to population, and cancer stage, patients with colon cancer living in micropolitan counties were more likely to receive chemotherapy than those living in rural counties (P<.001). Compared with patients aged 19 to 64 years, patients with colon cancer 85 years and older (P<.001 ) and patients with rectal cancer 75 years and older (P<.05) were less likely to undergo surgery. Patients with CRC 75 years and older were less likely to receive radiation, and patients with colon cancer 65 years and older and patients with rectal cancer 75 years and older were less likely to receive chemotherapy (P<.001 for both). Conclusions: In Nebraska, older patients with CRC were less likely to undergo surgery, radiation, and chemotherapy. Patients with colon cancer in rural counties were less likely to undergo chemotherapy than those in micropolitan counties. Decision makers need to consider issues of age and rural residence in patient access to CRC treatments.
AB - Objectives: To test the hypotheses that older patients with colorectal cancer (CRC) and rural patients are less likely to undergo surgery, radiation, and chemotherapy. Study Design: Retrospective study. Methods: A total of 6561 patients with CRC between January 1998 and December 2003 were identified by incident International Classification of Diseases for Oncology codes from the Nebraska Cancer Registry. In multivariate logistic regression analyses, we studied the association of age and residence county (rural vs urban and micropolitan) with each of 3 CRC treatments by anatomic site. Results: After adjusting for patient demographics, insurance payer, ratio of providers to population, and cancer stage, patients with colon cancer living in micropolitan counties were more likely to receive chemotherapy than those living in rural counties (P<.001). Compared with patients aged 19 to 64 years, patients with colon cancer 85 years and older (P<.001 ) and patients with rectal cancer 75 years and older (P<.05) were less likely to undergo surgery. Patients with CRC 75 years and older were less likely to receive radiation, and patients with colon cancer 65 years and older and patients with rectal cancer 75 years and older were less likely to receive chemotherapy (P<.001 for both). Conclusions: In Nebraska, older patients with CRC were less likely to undergo surgery, radiation, and chemotherapy. Patients with colon cancer in rural counties were less likely to undergo chemotherapy than those in micropolitan counties. Decision makers need to consider issues of age and rural residence in patient access to CRC treatments.
UR - http://www.scopus.com/inward/record.url?scp=77951589730&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77951589730&partnerID=8YFLogxK
M3 - Article
C2 - 20394462
AN - SCOPUS:77951589730
SN - 1088-0224
VL - 16
SP - 265
EP - 273
JO - American Journal of Managed Care
JF - American Journal of Managed Care
IS - 4
ER -