Sociodemographic differences in the receipt of colorectal cancer surveillance care following treatment with curative intent

被引:56
作者
Lafata, JE
Johnson, CC
Ben-Menachem, T
Morlock, RJ
机构
[1] Henry Ford Hlth Syst, Ctr Hlth Serv Res, Detroit, MI 48202 USA
[2] Henry Ford Med Grp, Div Gastroenterol, Detroit, MI USA
[3] Henry Ford Hlth Syst, Josephine Ford Canc Ctr, Detroit, MI 48202 USA
关键词
colorectal cancer; surveillance; health care utilization; race; income;
D O I
10.1097/00005650-200104000-00007
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
BACKGROUND. Despite limited evidence of its effectiveness, most guidelines recommend colorectal cancer survivors undergo posttreatment surveillance care. This article describes the posttreatment use of colon examinations, carcinoembryonic antigen (CEA) testing, and metastatic disease testing among a managed care population. METHODS. Two hundred fifty-one patients with colorectal cancer enrolled in a managed care organization at diagnosis (1/1/90-12/31/95) and treated with curative intent Patients were identified via a Cancer Registry maintained by a large group practice. Cumulative incidences of service receipt were estimated using actuarial (Kaplan-Meier) survival analyses. Cox Proportional Hazard Models were used to evaluate the relation of patient sociodemographic and clinical characteristics to service receipt. Average 8-year medical care expenditures were calculated. RESULTS. Within 18 months of treatment, 55% of the cohort received a colon examination, 71% received CEA testing, and 59% received metastatic disease testing. Whites were more likely than minorities to receive CEA testing (RR = 1.47, P = 0.04) and tended to be more likely to receive a colon examination (RR = 1.43, P = 0.09). As the median household income of a patient's zip code of residence increased, so too did the likelihood of colon examination and metastatic disease testing receipt (RR = 1.09, P = 0.03 and RR = 1.12, P < 0.01, respectively). Average 8-year medical care expenditures among the cohort were $30,247. CONCLUSIONS. Among a population with financial access to care, differences were found in the receipt of colorectal cancer surveillance fare by race and income. Additional investigations are needed to understand why minorities and those residing in low-income areas are less likely to receive surveillance care.
引用
收藏
页码:361 / 372
页数:12
相关论文
共 61 条
[1]   Racial differences in the treatment of early-stage lung cancer [J].
Bach, PB ;
Cramer, LD ;
Warren, JL ;
Begg, CB .
NEW ENGLAND JOURNAL OF MEDICINE, 1999, 341 (16) :1198-1205
[2]   The appropriate use of colonoscopy in the curative management of colorectal cancer [J].
Barrier, A ;
Houry, S ;
Huguier, M .
INTERNATIONAL JOURNAL OF COLORECTAL DISEASE, 1998, 13 (02) :93-98
[3]   DOES METHODIC LONG-TERM FOLLOW-UP AFFECT SURVIVAL AFTER CURATIVE RESECTION OF COLORECTAL-CARCINOMA [J].
BOHM, B ;
SCHWENK, W ;
HUCKE, HP ;
STOCK, W .
DISEASES OF THE COLON & RECTUM, 1993, 36 (03) :280-286
[4]   FOLLOW-UP OF PATIENTS WITH COLORECTAL-CANCER - A METAANALYSIS [J].
BRUINVELS, DJ ;
STIGGELBOUT, AM ;
KIEVIT, J ;
VANHOUWELINGEN, HC ;
HABBEMA, JDF ;
VANDEVELDE, CJH .
ANNALS OF SURGERY, 1994, 219 (02) :174-182
[5]  
BUHLER H, 1984, CANCER, V54, P791, DOI 10.1002/1097-0142(19840901)54:5<791::AID-CNCR2820540502>3.0.CO
[6]  
2-R
[7]   Black women receive less mammography even with similar use of primary care [J].
Burns, RB ;
McCarthy, EP ;
Freund, KM ;
Marwill, SL ;
Shwartz, M ;
Ash, A ;
Moskowitz, MA .
ANNALS OF INTERNAL MEDICINE, 1996, 125 (03) :173-+
[8]  
Cooper GS, 1999, CANCER-AM CANCER SOC, V85, P2124, DOI 10.1002/(SICI)1097-0142(19990515)85:10<2124::AID-CNCR5>3.0.CO
[9]  
2-L
[10]   Surgery for colorectal cancer: Race-related differences in rates and survival among Medicare beneficiaries [J].
Cooper, GS ;
Yuan, Z ;
Landefeld, CS ;
Rimm, AA .
AMERICAN JOURNAL OF PUBLIC HEALTH, 1996, 86 (04) :582-586