Factors Contributing to Delay in Specialist Care After Colorectal Cancer Diagnosis in Kentucky

Zeta Chow, Patrick Osterhaus, Bin Huang, Quan Chen, Nancy Schoenberg, Mark Dignan, B. Mark Evers, Avinash Bhakta

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Abundant studies have associated colorectal cancer (CRC) treatment delay with advanced diagnosis and worse mortality. Delay in seeking specialist is a contributor to CRC treatment delay. The goal of this study is to investigate contributing factors to 14-d delay from diagnosis of CRC on colonoscopy to the first specialist visit in the state of Kentucky. Methods: The Kentucky Cancer Registry (KCR) database linked with health administrative claims data was queried to include adult patients diagnosed with stage I-IV CRC from January 2007 to December 2012. The dates of the last colonoscopy and the first specialist visit were identified through the claims. Bivariate and logistic regression analysis was performed to identify factors associated with delay to CRC specialist visit. Results: A total of 3927 patients from 100 hospitals in Kentucky were included. Approximately, 19% of patients with CRC visited a specialist more than 14 d after CRC detection on colonoscopy. Delay to specialist (DTS) was found more likely in patients with Medicaid insurance (OR 3.1, P < 0.0001), low and moderate education level (OR 1.4 and 1.3, respectively, P = 0.0127), and stage I CRC (OR 1.5, P < 0.0001). There was a higher percentage of delay to specialist among Medicaid patients (44.0%) than Medicare (18.0%) and privately insured patients (18.8%). Conclusions: We identified Medicaid insurance, low education attainment, and early stage CRC diagnosis as independent risk factors associated with 14-d delay in seeking specialist care after CRC detection on colonoscopy.

Original languageEnglish
Pages (from-to)420-430
Number of pages11
JournalJournal of Surgical Research
Volume259
DOIs
StatePublished - Mar 2021

Bibliographical note

Funding Information:
We would like to acknowledge and thank the Markey Cancer Center Biostatistics and Bioinformatics and Cancer Research Informatics Shared Resource Facilities of the University of Kentucky Markey Cancer Center (supported by National Cancer Institute grant P30 CA177558 ) for statistical analyses and for obtaining Kentucky CRC patient data and analysis from the Kentucky Cancer Registry, respectively. In addition, we thank the Center for Clinical and Translational Sciences, supported by the National Center for Advancing Translational Sciences grant UL1 TR001998 , for assistance with data extraction. Dr Zeta Chow is supported by National Cancer Institute postdoctoral training grant T32 CA160003 . Bin Huang and Quan Chen are supported by the Centers of Disease Control and Prevention ( IU48DP005014-07 SIP14-017). In addition, Bin Huang is supported by the National Cancer Center Support Grant ( P30 CA177558 ). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the grant funding agencies.

Funding Information:
We would like to acknowledge and thank the Markey Cancer Center Biostatistics and Bioinformatics and Cancer Research Informatics Shared Resource Facilities of the University of Kentucky Markey Cancer Center (supported by National Cancer Institute grant P30 CA177558) for statistical analyses and for obtaining Kentucky CRC patient data and analysis from the Kentucky Cancer Registry, respectively. In addition, we thank the Center for Clinical and Translational Sciences, supported by the National Center for Advancing Translational Sciences grant UL1 TR001998, for assistance with data extraction. Dr Zeta Chow is supported by National Cancer Institute postdoctoral training grant T32 CA160003. Bin Huang and Quan Chen are supported by the Centers of Disease Control and Prevention (IU48DP005014-07 SIP14-017). In addition, Bin Huang is supported by the National Cancer Center Support Grant (P30 CA177558). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the grant funding agencies.

Publisher Copyright:
© 2020

Keywords

  • Colorectal cancer
  • Delays
  • Eastern Kentucky Appalachia

ASJC Scopus subject areas

  • Surgery

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