Nonadherence to Standard of Care for Locally Advanced Colon Cancer as a Contributory Factor for High Mortality Rates in Kentucky

Zeta Chow; Tong Gan; Quan Chen; Bin Huang; Nancy Schoenberg; Mark Dignan; B. Mark Evers; Avinash S. Bhakta

doi:10.1016/j.jamcollsurg.2019.12.041

Nonadherence to Standard of Care for Locally Advanced Colon Cancer as a Contributory Factor for High Mortality Rates in Kentucky

Zeta Chow, Tong Gan, Quan Chen, Bin Huang, Nancy Schoenberg, Mark Dignan, B. Mark Evers, Avinash S. Bhakta

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Background: Kentucky has one of the highest mortality rates for colon cancer, despite dramatic improvements in screening. The National Comprehensive Cancer Network (NCCN) guidelines recommend operation and adjuvant chemotherapy for locally advanced (stage IIb/c and stage III) colon cancer (LACC). The purpose of this study was to determine the rate of nonadherence with current standard of care (SOC) and associated factors as possible contributors to mortality. Methods: The Kentucky Cancer Registry database linked with administrative health claims was queried for individuals (20 years and older) diagnosed with LACC from 2007 to 2012. Bivariate and logistic regression of nonadherence was performed. Survival analysis was performed with Cox regression and Kaplan-Meier plots. Results: A total of 1,404 patients with LACC were included. Approximately 42% of patients with LACC were noted to be nonadherent to SOC, with nearly all (95.7%) failing to receive adjuvant chemotherapy. After adjusting for all significant factors, we found the factors associated with nonadherence included the following: age older than 75 years, stage III colon cancer, high Charlson Comorbidity Index (3+), low poverty level, Medicaid coverage, and disability. Adherence to SOC is associated with a significant improvement in the 5-year survival rate compared with nonadherence (63.0% and 27.4%, respectively; p < 0.0001). Conclusions: Our study identified multiple factors associated with the failure of patients with LACC to receive SOC, particularly adjuvant chemotherapy, suggesting the need to focus on improving adjuvant chemotherapy compliance in specific populations. Nonadherence to LACC SOC is likely a major contributor to the persistently high mortality rates in Kentucky.

Original language	English
Pages (from-to)	428-439
Number of pages	12
Journal	Journal of the American College of Surgeons
Volume	230
Issue number	4
DOIs	https://doi.org/10.1016/j.jamcollsurg.2019.12.041
State	Published - Apr 2020

Bibliographical note

Funding Information:
Support: Dr Chow is supported by a National Cancer Institute postdoctoral training grant (T32 CA160003). Drs Huang and Chen are supported by the Centers for Disease Control and Prevention (IU48DP005014-07 SIP14-017). Additionally, Dr Huang is supported by a National Cancer Center support grant (P30 CA177558). Assistance with data extraction was accommodated by a National Center for Advancing Translational Sciences grant (UL1 TR001998).The authors 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. Disclaimer: 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:
Support: Dr Chow is supported by a National Cancer Institute postdoctoral training grant ( T32 CA160003 ). Drs Huang and Chen are supported by the Centers for Disease Control and Prevention ( IU48DP005014-07 SIP14-017). Additionally, Dr Huang is supported by a National Cancer Center support grant ( P30 CA177558 ). Assistance with data extraction was accommodated by a National Center for Advancing Translational Sciences grant ( UL1 TR001998 ).

Funding Information:
The authors 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.

Publisher Copyright:
© 2020 American College of Surgeons

ASJC Scopus subject areas

Surgery

UN SDGs

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

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10.1016/j.jamcollsurg.2019.12.041

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@article{4b33dcd16a7e4d2186495383d2050c25,

title = "Nonadherence to Standard of Care for Locally Advanced Colon Cancer as a Contributory Factor for High Mortality Rates in Kentucky",

abstract = "Background: Kentucky has one of the highest mortality rates for colon cancer, despite dramatic improvements in screening. The National Comprehensive Cancer Network (NCCN) guidelines recommend operation and adjuvant chemotherapy for locally advanced (stage IIb/c and stage III) colon cancer (LACC). The purpose of this study was to determine the rate of nonadherence with current standard of care (SOC) and associated factors as possible contributors to mortality. Methods: The Kentucky Cancer Registry database linked with administrative health claims was queried for individuals (20 years and older) diagnosed with LACC from 2007 to 2012. Bivariate and logistic regression of nonadherence was performed. Survival analysis was performed with Cox regression and Kaplan-Meier plots. Results: A total of 1,404 patients with LACC were included. Approximately 42% of patients with LACC were noted to be nonadherent to SOC, with nearly all (95.7%) failing to receive adjuvant chemotherapy. After adjusting for all significant factors, we found the factors associated with nonadherence included the following: age older than 75 years, stage III colon cancer, high Charlson Comorbidity Index (3+), low poverty level, Medicaid coverage, and disability. Adherence to SOC is associated with a significant improvement in the 5-year survival rate compared with nonadherence (63.0% and 27.4%, respectively; p < 0.0001). Conclusions: Our study identified multiple factors associated with the failure of patients with LACC to receive SOC, particularly adjuvant chemotherapy, suggesting the need to focus on improving adjuvant chemotherapy compliance in specific populations. Nonadherence to LACC SOC is likely a major contributor to the persistently high mortality rates in Kentucky.",

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

note = "Funding Information: Support: Dr Chow is supported by a National Cancer Institute postdoctoral training grant (T32 CA160003). Drs Huang and Chen are supported by the Centers for Disease Control and Prevention (IU48DP005014-07 SIP14-017). Additionally, Dr Huang is supported by a National Cancer Center support grant (P30 CA177558). Assistance with data extraction was accommodated by a National Center for Advancing Translational Sciences grant (UL1 TR001998).The authors 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. Disclaimer: 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: Support: Dr Chow is supported by a National Cancer Institute postdoctoral training grant ( T32 CA160003 ). Drs Huang and Chen are supported by the Centers for Disease Control and Prevention ( IU48DP005014-07 SIP14-017). Additionally, Dr Huang is supported by a National Cancer Center support grant ( P30 CA177558 ). Assistance with data extraction was accommodated by a National Center for Advancing Translational Sciences grant ( UL1 TR001998 ). Funding Information: The authors 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. Publisher Copyright: {\textcopyright} 2020 American College of Surgeons",

year = "2020",

month = apr,

doi = "10.1016/j.jamcollsurg.2019.12.041",

language = "English",

volume = "230",

pages = "428--439",

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TY - JOUR

T1 - Nonadherence to Standard of Care for Locally Advanced Colon Cancer as a Contributory Factor for High Mortality Rates in Kentucky

AU - Chow, Zeta

AU - Gan, Tong

AU - Chen, Quan

AU - Huang, Bin

AU - Schoenberg, Nancy

AU - Dignan, Mark

AU - Evers, B. Mark

AU - Bhakta, Avinash S.

N1 - Funding Information: Support: Dr Chow is supported by a National Cancer Institute postdoctoral training grant (T32 CA160003). Drs Huang and Chen are supported by the Centers for Disease Control and Prevention (IU48DP005014-07 SIP14-017). Additionally, Dr Huang is supported by a National Cancer Center support grant (P30 CA177558). Assistance with data extraction was accommodated by a National Center for Advancing Translational Sciences grant (UL1 TR001998).The authors 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. Disclaimer: 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: Support: Dr Chow is supported by a National Cancer Institute postdoctoral training grant ( T32 CA160003 ). Drs Huang and Chen are supported by the Centers for Disease Control and Prevention ( IU48DP005014-07 SIP14-017). Additionally, Dr Huang is supported by a National Cancer Center support grant ( P30 CA177558 ). Assistance with data extraction was accommodated by a National Center for Advancing Translational Sciences grant ( UL1 TR001998 ). Funding Information: The authors 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. Publisher Copyright: © 2020 American College of Surgeons

PY - 2020/4

Y1 - 2020/4

N2 - Background: Kentucky has one of the highest mortality rates for colon cancer, despite dramatic improvements in screening. The National Comprehensive Cancer Network (NCCN) guidelines recommend operation and adjuvant chemotherapy for locally advanced (stage IIb/c and stage III) colon cancer (LACC). The purpose of this study was to determine the rate of nonadherence with current standard of care (SOC) and associated factors as possible contributors to mortality. Methods: The Kentucky Cancer Registry database linked with administrative health claims was queried for individuals (20 years and older) diagnosed with LACC from 2007 to 2012. Bivariate and logistic regression of nonadherence was performed. Survival analysis was performed with Cox regression and Kaplan-Meier plots. Results: A total of 1,404 patients with LACC were included. Approximately 42% of patients with LACC were noted to be nonadherent to SOC, with nearly all (95.7%) failing to receive adjuvant chemotherapy. After adjusting for all significant factors, we found the factors associated with nonadherence included the following: age older than 75 years, stage III colon cancer, high Charlson Comorbidity Index (3+), low poverty level, Medicaid coverage, and disability. Adherence to SOC is associated with a significant improvement in the 5-year survival rate compared with nonadherence (63.0% and 27.4%, respectively; p < 0.0001). Conclusions: Our study identified multiple factors associated with the failure of patients with LACC to receive SOC, particularly adjuvant chemotherapy, suggesting the need to focus on improving adjuvant chemotherapy compliance in specific populations. Nonadherence to LACC SOC is likely a major contributor to the persistently high mortality rates in Kentucky.

AB - Background: Kentucky has one of the highest mortality rates for colon cancer, despite dramatic improvements in screening. The National Comprehensive Cancer Network (NCCN) guidelines recommend operation and adjuvant chemotherapy for locally advanced (stage IIb/c and stage III) colon cancer (LACC). The purpose of this study was to determine the rate of nonadherence with current standard of care (SOC) and associated factors as possible contributors to mortality. Methods: The Kentucky Cancer Registry database linked with administrative health claims was queried for individuals (20 years and older) diagnosed with LACC from 2007 to 2012. Bivariate and logistic regression of nonadherence was performed. Survival analysis was performed with Cox regression and Kaplan-Meier plots. Results: A total of 1,404 patients with LACC were included. Approximately 42% of patients with LACC were noted to be nonadherent to SOC, with nearly all (95.7%) failing to receive adjuvant chemotherapy. After adjusting for all significant factors, we found the factors associated with nonadherence included the following: age older than 75 years, stage III colon cancer, high Charlson Comorbidity Index (3+), low poverty level, Medicaid coverage, and disability. Adherence to SOC is associated with a significant improvement in the 5-year survival rate compared with nonadherence (63.0% and 27.4%, respectively; p < 0.0001). Conclusions: Our study identified multiple factors associated with the failure of patients with LACC to receive SOC, particularly adjuvant chemotherapy, suggesting the need to focus on improving adjuvant chemotherapy compliance in specific populations. Nonadherence to LACC SOC is likely a major contributor to the persistently high mortality rates in Kentucky.

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Nonadherence to Standard of Care for Locally Advanced Colon Cancer as a Contributory Factor for High Mortality Rates in Kentucky

Abstract

Bibliographical note

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UN SDGs

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