Surgery and adjuvant chemotherapy use among veterans with colon cancer: insights from a California study.
OBJECTIVE
US veterans have been shown to be a vulnerable population with high cancer rates, and cancer care quality in Veterans Affairs (VA) hospitals is the focus of a congressionally mandated review. We examined rates of surgery and chemotherapy use among veterans with colon cancer at VA and non-VA facilities in California to gain insight into factors associated with quality of cancer care.


METHODS
A retrospective cohort of incident colon cancer patients from the California Cancer Registry, who were > or = 66 years old and eligible to use VA and Medicare between 1999 and 2001, were observed for 6 months after diagnosis.


RESULTS
Among 601 veterans with colon cancer, 72% were initially diagnosed and treated in non-VA facilities. Among veterans with stage I to III cancer, those diagnosed and initially treated in VA facilities experienced similar colectomy rates as those at non-VA facilities. Stage III patients diagnosed and initially treated in VA versus non-VA facilities had similar odds of receiving adjuvant chemotherapy. In both settings, older patients had lower odds of receiving chemotherapy than their younger counterparts even when race and comorbidity were considered (age 76 to 85 years: odds ratio [OR] = 0.18; 95% CI, 0.07 to 0.46; age > or = 86 years: OR = 0.17; 95% CI, 0.04 to 0.73).


CONCLUSIONS
In California, older veterans with colon cancer used both VA and non-VA facilities for cancer treatment, and odds of receiving cancer-directed surgery and chemotherapy were similar in both systems. Among stage III patients, older age lowered odds of receiving adjuvant chemotherapy in both systems. Further studies should continue to explore potential health system effects on quality of colon cancer care across the United States.
Hynes
Denise M
DM
Center for Management of Complex Chronic Care, VA Information Resource Center, Edward Hines VA Hospital, 5000 Hines, IL 60141, USA. denise.hynes@va.gov
Tarlov
Elizabeth
E
Durazo-Arvizu
Ramon
R
Perrin
Ruth
R
Zhang
Qiuying
Q
Weichle
Thomas
T
Ferreira
M Rosario
MR
Lee
Todd
T
Benson
Al B
AB
Bhoopalam
Nirmala
N
Bennett
Charles L
CL
D000368:Aged; D000369:Aged, 80 and over; D002140:California; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006787:Hospitals, Veterans / Q000191:economics / Q000592:standards; D006801:Humans; D008297:Male; D011787:Quality of Health Care; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics / Q000592:standards; D014728:Veterans
Med Care. 2003 Sep;41(9):1006-12
12972840
J Gen Intern Med. 1999 May;14(5):274-80
10337036
J Clin Epidemiol. 1993 Oct;46(10):1075-9; discussion 1081-90
8410092
Lancet. 1995 Apr 15;345(8955):939-44
7715291
Ann Oncol. 2003 Mar;14(3):395-9
12598344
N Engl J Med. 1990 Feb 8;322(6):352-8
2300087
Med Care. 2007 Mar;45(3):214-23
17304078
CA Cancer J Clin. 2006 Mar-Apr;56(2):106-30
16514137
Med Care. 2006 Oct;44(10):921-8
17001263
Clin Colorectal Cancer. 2009 Jan;8(1):22-8
19203893
Implement Sci. 2009 Feb 26;4:8
19245708
Cancer J. 2001 May-Jun;7(3):213-8
11419029
J Clin Epidemiol. 1992 Jun;45(6):613-9
1607900
Cancer. 1998 Jun 15;82(12):2312-20
9635522
J Clin Oncol. 2003 Apr 1;21(7):1293-300
12663717
JAMA. 1990 Sep 19;264(11):1444-50
2202842
Am J Gastroenterol. 2003 May;98(5):1186-92
12809847
J Clin Epidemiol. 2000 Dec;53(12):1258-67
11146273
Cancer. 2007 Apr 15;109(8):1607-16
17343277
Am J Gastroenterol. 2006 Jun;101(6):1320-8
16771956
Cancer Causes Control. 2007 Mar;18(2):177-87
17219013
Eff Clin Pract. 2002 May-Jun;5(3 Suppl):E4
12166925
J Natl Cancer Inst. 2001 Jun 6;93(11):850-7
11390534
JAMA. 2005 Dec 7;294(21):2703-11
16333005
J Clin Epidemiol. 1994 Nov;47(11):1245-51
7722560