Factors associated with late stage at diagnosis among Puerto Rico’s government health plan colorectal cancer patients: a cross-sectional study

Abstract

BackgroundLate stage at diagnosis of cancer is considered a key predictor factor for a lower survival rate. Knowing and understanding the barriers to an early diagnosis of colorectal cancer is critical in the fight to reduce the social and economic burden caused by cancer in Puerto Rico. This study evaluates factors associated to colorectal cancer stage at diagnosis among Puerto Rico’s Government Health Plan (GHP) patients.MethodsWe conducted a cross-sectional study based on a secondary data analysis using information from the Puerto Rico Central Cancer Registry (PRCCR) and the Puerto Rico Health Insurance Administration (PRHIA). Logistic regression models were used to estimate the unadjusted odds ratio (ORs) and adjusted odds ratio (AORs), and their 95 % confidence intervals (CIs). Colorectal cancer cases diagnosed between January 1, 2012 and December 31, 2012, among persons 50 to 64 years of age, participants of the GHP and with a cancer diagnosis reported to the PRCCR were included in the study.ResultsThere were 68 (35.79 %) colorectal cancer patients diagnosed at early stage while 122 (64.21 %) where diagnosed at late stage. In the multivariate analysis having a diagnostic delay of more than 59 days (AOR 2.94, 95 % CI: 1.32 to 6.52) and having the first visit through the emergency room (AOR 3.48, 95 % CI: 1.60 to 7.60) were strong predictors of being diagnosed with colorectal cancer at a late stage.ConclusionsThese results are relevant to understand the factors that influence the outcomes of colorectal cancer patients in the GHP. Therefore, it is important to continue developing studies to understand the Government Health Plan patient’s pathways to a cancer diagnosis, in order to promote assertive decisions to improve patient outcomes.

Assessing Colorectal Cancer Knowledge Among Puerto Rican Hispanics: Implications for Cancer Prevention and Control

“…The lack of CRC screening recommendations by physicians is one of the most common barriers among persons who do not undergo CRC testing [38]. These findings support the leading role that health care providers play in CRC screening behaviors, particularly in minority populations [39]. The factors limiting an effective education about CRC must be identified and addressed; physicians and other healthcare providers should be given tools to discuss the importance of CRC screening with their patients in adequate and culturally appropriate manner.…”

“…Specifically, patients diagnosed with CRC who had the Puerto Rico government health plan (Medicaid) were diagnosed at more advanced stages, had worse survival, and had greater excess risk of death, than individuals with non-government health plan [43]. In addition, a recent study about colorectal cancer in PR reported that the factors associated with late CRC stage in individuals with government health plan were: (1) having their first visit for CRC diagnosis trough the emergency room, and (2) having a diagnostic delay of more than 59 days, in comparison with early stage diagnosed CRC cases [44]. These findings suggest that type of health insurance coverage is an independent factor associated with CRC screening rates.…”

Advanced stage presentation and its determinant factors among colorectal cancer patients in Amhara regional state Referral Hospitals, Northwest Ethiopia

“…Patients who delayed visiting a health care facility after the appearance of the first sign/ symptom presented with advanced stage than those who did not. This is supported by studies in Puerto Rico [34], Botswana [35], and Spain [36]. This could be since if patients don't visit health care facilities and their physicians as early as possible after the sign/symptom, the disease could metastasize and disseminate to different organs [37].…”

Squamous Cell Carcinoma of the Anus Incidence, Mortality, and Survival Among the General Population and Persons Living With HIV in Puerto Rico, 2000-2016

“…30 , 31 This could potentially lead to more advanced stage at diagnosis and/or delayed access to preventive and treatment services as research has shown that patients with public health coverage in PR experience longer waiting times to schedule an appointment, to see a specialist, and to receive cancer treatment. 10 , 30 , 32 – 35 More studies are needed to understand how type of health coverage affects survival in PR.…”