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

doi:10.1016/j.jss.2020.09.012

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 journal › Article › peer-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 language	English
Pages (from-to)	420-430
Number of pages	11
Journal	Journal of Surgical Research
Volume	259
DOIs	https://doi.org/10.1016/j.jss.2020.09.012
State	Published - 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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jss.2020.09.012

Cite this

@article{a3890614ff4c48edabc87f9ca47c3e11,

title = "Factors Contributing to Delay in Specialist Care After Colorectal Cancer Diagnosis in Kentucky",

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.",

keywords = "Colorectal cancer, Delays, Eastern Kentucky Appalachia",

author = "Zeta Chow and Patrick Osterhaus and Bin Huang and Quan Chen and Nancy Schoenberg and Mark Dignan and Evers, {B. Mark} and Avinash Bhakta",

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: {\textcopyright} 2020",

year = "2021",

month = mar,

doi = "10.1016/j.jss.2020.09.012",

language = "English",

volume = "259",

pages = "420--430",

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TY - JOUR

T1 - Factors Contributing to Delay in Specialist Care After Colorectal Cancer Diagnosis in Kentucky

AU - Chow, Zeta

AU - Osterhaus, Patrick

AU - Huang, Bin

AU - Chen, Quan

AU - Schoenberg, Nancy

AU - Dignan, Mark

AU - Evers, B. Mark

AU - Bhakta, Avinash

N1 - 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

PY - 2021/3

Y1 - 2021/3

N2 - 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.

AB - 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.

KW - Colorectal cancer

KW - Delays

KW - Eastern Kentucky Appalachia

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DO - 10.1016/j.jss.2020.09.012

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

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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Cite this