Ethnicity, socioeconomic status, income inequality, and colorectal cancer outcomes: evidence from the 4C2 collaboration.

PURPOSE: National Cancer Institute (NCI)-Designated Cancer Centers are required to assess and address the needs of their catchments. In rural regions, catchment areas are vast, populations small, and infrastructure for data capture limited, making analyses of cancer patterns challenging. METHODS: The four NCI-Designated Comprehensive Cancer Centers in the southern Rocky Mountain region formed the Four Corners Collaboration (4C2) to address these challenges. Colorectal cancer (CRC) was identified as a disease site where disparities exist. The 4C2 leaders examined how geographic and sociodemographic characteristics were correlated to stage at diagnosis and survival in the region and compared those relationships to a sample from the surveillance, epidemiology, and end results (SEER) program. RESULTS: In 4C2, Hispanics were more likely to live in socioeconomically disadvantaged areas relative to their counterparts in the SEER program. These residency patterns were positively correlated with later stage diagnosis and higher mortality. Living in an area with high-income inequality was positively associated with mortality for Non-Hispanic whites in 4C2. In SEER, Hispanics had a slightly higher likelihood of distant stage disease, and disadvantaged socioeconomic status was associated with poor survival. CONCLUSION: CRC interventions in 4C2 will target socioeconomically disadvantaged areas, especially those with higher income inequality, to improve outcomes among Hispanics and Non-Hispanic whites. The collaboration demonstrates how bringing NCI-Designated Cancer Centers together to identify and address common population catchment issues provides opportunity for pooled analyses of small, but important populations, and thus, capitalize on synergies among researchers to reduce cancer disparities.

Characterizing employment of colorectal cancer survivors using electronic health records.

OBJECTIVE: Although the value of collecting occupational data is well-established, these data are not systematically collected in clinical practice. We assessed the availability of electronic health record (EHR)-based occupation data within a large integrated health care system to determine the feasibility of its use in research. MATERIALS AND METHODS: We used a mixed-methods approach to extract EHR data and define employment status, employer, and employment industry of 1107 colorectal cancer survivors. This was a secondary analysis of a subset of the Patient Outcomes Research to Advance Learning (PORTAL) colorectal cancer cohort. RESULTS: We categorized the employment industry for 46% of the cohort. Employment status was available for 58% of the cohort. The employer was missing for over 95% of the cohort. CONCLUSION: By combining data from structured and free-text EHR fields, we identified employment status and industry for approximately half of our sample. Findings demonstrate limitations of EHR data and underscore the need for systematic collection of occupation data in clinical practice.

Dually eligible and colorectal cancer screening: too little, too late?

BACKGROUND: Cancer screening reduces late-stage diagnosis. Medicare and Medicaid dually eligible patients receive more late stage colorectal cancer (CRC) diagnoses. METHODS: Characteristics of CRC patients diagnosed between 1997 and 2000 were extracted from the Michigan Tumor Registry and Medicare administrative data, Area Resource File, and U.S. Census to assess CRC screening (fecal occult blood testing (FOBT), barium enema, colonoscopy, and sigmoidoscopy) and late stage CRC diagnosis. RESULTS: Adjusted logistic regression models indicated dually eligible patients received less CRC screening (OR 0.68, 95% CI 0.59-0.78, p<.001). There was less late-stage diagnosis with colonoscopy receipt (OR 0.60, 95% CI 0.53-0.69, p<.001), sigmoidoscopy (OR 0.77, 95% CI 0.67-0.89, p<.001), and FOBT (OR 0.77, 95% CI 0.70-0.86, p<.01), but more if patients were dually eligible (OR 1.28, 95% CI=1.12-1.46, p<0.001). CONCLUSIONS: Dually eligible CRC patients were screened less and diagnosed later than Medicare patients. Fecal occult blood testing remains a less invasive and less costly screening option that may reduce late-stage diagnosis in low income populations.