title: Treatment and Survival of Medicare Beneficiaries with Colorectal Cancer: A Comparative Analysis Between a Rural State Cancer Registry and National Data.
abstract: The aim was to examine and compare with "national" estimates, receipt of colorectal cancer (CRC) treatment in the initial phase of care and survival following a CRC diagnosis in rural Medicare beneficiaries. A retrospective study was conducted on fee-for-service Medicare beneficiaries diagnosed with CRC in 2003-2006, identified from West Virginia Cancer Registry (WVCR)-Medicare linked database (N = 2119). A comparative cohort was identified from Surveillance, Epidemiology, and End Results (SEER)-Medicare (N = 38,168). CRC treatment received was ascertained from beneficiaries' Medicare claims in the 12 months post CRC diagnosis or until death, whichever happened first. Receipt of minimally appropriate CRC treatment (MACT) was defined using recommended CRC treatment guidelines. All-cause and CRC-specific mortality in the 36-month period post CRC diagnosis were examined. Differences in usage of CRC surgery, chemotherapy, and radiation were observed between the 2 populations, with those from WVCR-Medicare being less likely to receive any type of CRC surgery (adjusted odds ratio [AOR] = 0.82; 95% confidence interval [CI] = [0.73-0.93]). Overall, those from WVCR-Medicare had a lower likelihood of receiving MACT, (AOR = 0.85; 95% CI = [0.76-0.96]) compared to their national counterparts. Higher hazard of CRC mortality was observed in the WVCR-Medicare cohort (adjusted hazard ratio = 1.26; 95% CI = [1.20-1.32]) compared to the SEER-Medicare cohort. Although more beneficiaries from WVCR-Medicare were diagnosed in early-stage CRC compared to their SEER-Medicare counterparts, they had a lower likelihood of receiving MACT and a higher hazard of CRC mortality. This study highlights the need for an increased focus on improving access to care at every phase of the CRC care continuum, especially for those from rural settings.
authors.affiliation: 1 Center for the Evaluation of Value and Risk in Health, Tufts Medical Center Institute for Clinical Research and Health Policy Studies , Boston, MA.
authors.forename: Pallavi B
authors.initials: PB
authors.lastname: Rane
authors.affiliation: 2 Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University , Morgantown, WV.
authors.forename: S Suresh
authors.initials: SS
authors.lastname: Madhavan
authors.affiliation: 2 Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University , Morgantown, WV.
authors.forename: Usha
authors.initials: U
authors.lastname: Sambamoorthi
authors.affiliation: 2 Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University , Morgantown, WV.
authors.forename: Kalidindi
authors.initials: K
authors.lastname: Sita
authors.affiliation: 3 Department of Radiology Hematology/Oncology, Mary Babb Randolph Cancer Center, West Virginia University , Morgantown, WV.
authors.forename: Sobha
authors.initials: S
authors.lastname: Kurian
authors.affiliation: 4 Evidera, Lexington, MA.
authors.forename: Xiaoyun
authors.initials: X
authors.lastname: Pan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012424:Rural Population; D018426:SEER Program; D016019:Survival Analysis; D014481:United States; D014903:West Virginia / Q000453:epidemiology