Socioeconomic and demographic disparities in treatment for carcinomas of the colon and rectum

VanEenwyk, Juliet; Campo, Joseph; Ossiander, Eric M.

doi:10.1002/cncr.10645

Cited by 64 publications

(49 citation statements)

References 24 publications

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“…Having Medicare rather than private insurance also resulted in less use of adjuvant treatment. 25 While these investigators did confirm a socioeconomic gradient, other investigators have failed to demonstrate an association. 22,[26][27][28] This disparity may be explained by investigators' use of different measures and classifications of socioeconomic position.…”

Section: Discussionmentioning

confidence: 95%

“…23 Studies of the impact socioeconomic variables have on adjuvant treatment in colon cancer parallel these findings. 24,25 Higher income patients, defined by per capita income at zip code level, experienced adjuvant treatment rates twice that of the lowest income patients. Having Medicare rather than private insurance also resulted in less use of adjuvant treatment.…”

Section: Discussionmentioning

confidence: 99%

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Sociodemographic factors associated with postprostatectomy radiotherapy

Krupski

Kwan

Litwin

2005

Prostate Cancer Prostatic Dis

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Purpose: To determine if nonclinical factors affect the use of adjuvant radiation therapy after surgical resection of the prostate gland. Methods: Using the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) public use data files, we identified men with localized/ regional prostate cancer who underwent postprostatectomy radiotherapy within 4 months of surgery. We used 2000 Census information to ascribe a median education and income level to these men based on the county of residence and ethnicity. Results: Of 34 763 men who underwent surgical resection, 1549 received postprostatectomy radiotherapy. Those with higher tumor grade and from certain geographic regions (Seattle and Hawaii) had significantly higher rates of radiotherapy while being older and from other geographic regions (Detroit, Utah, and New Mexico) was protective. The use of additional radiation therapy was not affected by ethnicity, income level, or educational attainment. Conclusions: We found no socioeconomic or demographic disparities in the receipt of postprostatectomy radiotherapy. Geographic variation in postprostatectomy radiotherapy may be explained by limited evidence supporting its use in clinical practice.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Sociodemographic factors associated with postprostatectomy radiotherapy

Krupski

Kwan

Litwin

2005

Prostate Cancer Prostatic Dis

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Section: Cihr Author Manuscriptmentioning

confidence: 99%

“…[16][17][18] Fourth, screening, diagnosis, and treatment of colon cancer are more accessible to persons with higher socioeconomic status in the United States. [18][19][20][21][22] Colon cancer screening is more prevalent among higher-income persons in Canada, 23 but no previous study has examined associations of socioeconomic status with colon cancer treatment in that country.Because past studies have not observed associations between socioeconomic status and breast cancer treatment in Canada, [3][4][5] we hypothesized that we would also find no significant correlation. Previous comparisons of colon cancer survival in Canada and the United States showed a significant advantage for Canadians only for low-income and not for middle-or high-income patients.…”

mentioning

confidence: 99%

Effects of Socioeconomic Status on Colon Cancer Treatment Accessibility and Survival in Toronto, Ontario, and San Francisco, California, 1996–2006

Gorey¹,

Luginaah²,

Bartfay³

et al. 2011

Am J Public Health

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Objectives-We examined the differential effects of socioeconomic status on colon cancer care and survival in Toronto, Ontario, Canada, and San Francisco, California.Methods-We analyzed registry data for colon cancer patients from Ontario (n=930) and California (n=1014), diagnosed between 1996 and 2000 and followed until 2006, on stage, surgery, adjuvant chemotherapy, and survival. We obtained socioeconomic data for individuals' residences from population censuses.Correspondence should be sent to Kevin Gorey, School of Social Work, University of Windsor, 401 Sunset Ave, Windsor, Ontario, N9B 3P4 gorey@uwindsor.ca. Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link. ContributorsK. M. Gorey conceptualized and supervised the study and led the writing. K. Y. Fung led the analysis. All authors assisted with study design, data analysis, and interpretation and writing. Human Participant Protection CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptResults-Income was directly associated with lymph node evaluation, chemotherapy, and survival in San Francisco but not in Toronto. High-income persons had better survival rates in San Francisco than in Toronto. After adjustment for stage, survival was better for low-income residents of Toronto than for those of San Francisco. Middle-to low-income patients were more likely to receive indicated chemotherapy in Toronto than in San Francisco.Conclusions-Socioeconomic factors appear to mediate colon cancer care in urban areas of the United States but not in Canada. Improvements are needed in screening, diagnostic investigations, and treatment access among low-income Americans.A study of cancer survival in low-income areas of Toronto, Ontario, and Detroit, Michigan, during the 1980s found advantages among Canadians for common cancers. 1 The Toronto survival advantage was replicated for breast cancer across diverse low-income Canadian and US contexts through the 1990s. 2 Studies of that era, however, were not able to account for differences in stage of disease at diagnosis. More recent studies that accounted for breast cancer stage again found Canadian advantages. [3][4][5][6] In the United States, women with breast cancer who lived in low-income areas waited longer for surgery and adjuvant radiation therapy and were less likely to receive radiation therapy or to survive. Similar disparities between high-and low-income women with breast cancer did not exist in Canada; thus lowincome Canadians fared better across most breast cancer care indices than their US counterparts. More inclusive health insurance in Canada was advanced as the most plausible explanation.Colon cancer care may be an even more important health care performance indicator. The second most frequent cause of cancer death in North America, its prognosis can be excellent with early diagnosis and treatment. 7,8 For several reasons, colon cancer seems particularly instructive for Canada-US cancer care comparisons. First, research on income and colon cancer survi...

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“…1,5 However, a significant proportion of patients do not receive chemotherapy. [6][7][8][9][10][11][12] Patients who are older, 7,8,10,13 female, 8,14 African American, 9,12,13 and not currently married 9,13 and who live in poverty areas 15 are less likely to receive chemotherapy after colectomy. Being seen by a medical oncologist has also been shown to predict chemotherapy receipt.…”

Section: Introductionmentioning

confidence: 99%

Association Between the Availability of Medical Oncologists and Initiation of Chemotherapy for Patients With Stage III Colon Cancer

Lin

Virgo²

2013

JOP

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Purpose: Although the number of medical oncologists (MOs) has steadily increased over time, and adjuvant chemotherapy provides significant survival benefit for patients with stage III colon cancer, many patients still do not receive chemotherapy. Uneven geographic distribution of MOs may contribute to decreasing access to cancer care. This study explored the association of MO availability by hospital service area (HSA) of patient residence and access to chemotherapy treatment. Methods:Using the linked SEER-Medicare database, the study identified 9,262 patients who were age Ն66 years and underwent colectomy for stage III colon cancer diagnosed from 2000 to 2005. MOs were identified by physician specialty codes. HSAs are geographic areas that are relatively self-contained with respect to routine hospital care. Multivariate logistic regression was used to investigate the association between MO availability by HSA of patient residence and initiation of chemotherapy.

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Socioeconomic and demographic disparities in treatment for carcinomas of the colon and rectum

Cited by 64 publications

References 24 publications

Sociodemographic factors associated with postprostatectomy radiotherapy

Sociodemographic factors associated with postprostatectomy radiotherapy

Effects of Socioeconomic Status on Colon Cancer Treatment Accessibility and Survival in Toronto, Ontario, and San Francisco, California, 1996–2006

Association Between the Availability of Medical Oncologists and Initiation of Chemotherapy for Patients With Stage III Colon Cancer

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