Impact of Primary Care Providers and Health Insurance Type on Colorectal Cancer Screening in the United States.

INTRODUCTION: Colorectal cancer (CRC) is a major cause of cancer deaths. We evaluated the effect of health insurance type and primary care provider (PCP) access on CRC screening. METHODS: HINTS data were used to analyze CRC screening. RESULTS: Individuals aged 50 to 65 years had comparable screening rates across all insurance types. Beyond 65 years, individuals with Medicare or Medicare with private insurance were more likely to undergo screening than private insurance users. PCP access increased CRC screening rates. Among PCP users, Medicare, income, and smoking status influenced screening. DISCUSSION: Medicare and PCP access influence CRC screening. All individuals should be linked with PCPs.

Prevalence and predictors of colorectal cancer screening in the United States: evidence from the HINTS database 2018 to 2020.

BACKGROUND: The incidence of colorectal cancer (CRC) and CRC-related mortality among young adults (< 50 years) has been on the rise. The American Cancer Society (ACS) reduced the CRC screening age to 45 in 2018. Few studies have examined the barriers to CRC screening among young adults. METHODS: Analyses were conducted using data from 7,505 adults aged 45-75 years who completed the 2018 to 2020 Health Information National Trends Survey. We examined the sociodemographic characteristics associated with CRC screening overall and by age group using separate multivariable logistic regression models. RESULTS: 76% of eligible adults had received screening for CRC. Increasing age, Black racial group [OR 1.45; 95% CI (1.07, 1.97)], having some college experience, a college degree or higher [OR 1.69; 95% CI (1.24, 2.29)], health insurance coverage [OR 4.48; 95% CI (2.96, 6.76)], primary care provider access [OR 2.48; 95% CI (1.91, 3.22)] and presence of a comorbid illness [OR 1.39; 95% CI (1.12, 1.73)] were independent predictors of CRC screening. Current smokers were less likely to undergo CRC screening [OR 0.59; 95% CI (0.40, 0.87)]. Among adults aged 50-64 years, being of Hispanic origin [OR 0.60; 95% CI (0.39, 0.92)] was associated with a lower likelihood of CRC screening. CONCLUSION: CRC screening rates among adults 45-49 years are low but are increasing steadily. Odds of CRC screening among Blacks is high which is encouraging while the odds among current smokers is low and concerning given their increased risk of developing CRC.

Clinical trial knowledge among cancer survivors in the United States: the role of health information technology.

PURPOSE: Clinical trials are essential to the advancement of cancer care. However, clinical trial knowledge and participation remain critically low among adult patients with cancer. Health information technology (HIT) could play an important role in improving clinical trial knowledge and engagement among cancer survivors. METHODS: We used data from 3,794 adults who completed the 2020 Health Information National Trends Survey, 626 (16.2%) of whom were cancer survivors. We examined the prevalence of HIT use in the study population and by cancer history using chi-squared tests. We used multivariable logistic regression models to examine the impact of HIT use on clinical trial knowledge for cancer survivors and respondents with no cancer history, respectively. RESULTS: Approximately 63.8% of cancer survivors reported having some knowledge of clinical trials. Almost half of the cancer survivors used HIT to communicate with doctors (47.1%) and make health appointments (49.4%), 68.0% used HIT to look up health information online and 42.2% used it to check test results. In the adjusted models, the use of HIT in communicating with doctors [OR 2.79; 95% CI (1.41, 5.54)], looking up health information online [OR 2.84; 95% CI (1.04, 7.77)], and checking test results [OR 2.47; 95% CI (1.12, 5.43)] was associated with having some knowledge of clinical trials. CONCLUSION: HIT use for engaging with the healthcare team and health information gathering is associated with higher clinical trial knowledge in cancer survivors. Given the rapid increase in mobile technology access globally and the increased use of HIT, digital technology can be leveraged to improve clinical trial knowledge and engagement among cancer survivors.

Rural-urban disparities and trends in utilization of palliative care services among US patients with metastatic breast cancer.

PURPOSE: To assess trends and rural-urban disparities in palliative care utilization among patients with metastatic breast cancer. METHODS: We analyzed data from the 2004-2019 National Cancer Database. Palliative care services, including surgery, radiotherapy, systemic therapy, and/or other pain management, were provided to control pain or alleviate symptoms; utilization was dichotomized as "yes/no." Rural-urban residence, defined by the US Department of Agriculture Economic Research Service's Rural-Urban Continuum Codes, was categorized as "rural/urban/metropolitan." Multivariable logistic regression was used to examine rural-urban differences in palliative care use. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated. FINDINGS: Of 133,500 patients (mean age 62.4 [SD = 14.2] years), 86.7%, 11.7%, and 1.6% resided in metropolitan, urban, and rural areas, respectively; 72.5% were White, 17.0% Black, 5.8% Hispanic, and 2.7% Asian. Overall, 20.3% used palliative care, with a significant increase from 15.6% in 2004-2005 to 24.5% in 2008-2019 (7.0% increase per year; p-value for trend <0.001). In urban areas, 23.3% received palliative care, compared to 21.0% in rural and 19.9% in metropolitan areas (p < 0.001). After covariate adjustment, patients residing in rural (AOR = 0.84; 95% CI: 0.73-0.98) or metropolitan (AOR = 0.85, 95% CI: 0.80-0.89) areas had lower odds of having used palliative care than those in urban areas. CONCLUSIONS: In this national, racially diverse sample of patients with metastatic breast cancer, the utilization of palliative care services increased over time, though remained suboptimal. Further, our findings highlight rural-urban disparities in palliative care use and suggest the potential need to promote these services while addressing geographic access inequities for this patient population.

Dry Beriberi Post Roux-en-Y Gastric Bypass Surgery.

Bariatric surgery is an effective strategy for achieving substantial weight loss, prolonging survival, and improving the comorbidities associated with obesity. Nutritional deficiency is a commonly recognized post-procedural complication. Here, we present a case of a patient with paresthesia, lower extremity weakness, and altered mental status one year following Roux-en-Y gastric bypass, who was found to have multiple vitamin and micronutrient deficiencies and was diagnosed with beriberi in the setting of profound thiamine deficiency.

Impact of Insurance Status on Late-Stage Disease Presentation and Disease-Specific Survival among US Patients With Gastric Cancer.

Purpose: The impact of insurance status on cause-specific survival and late-stage disease presentation among US patients with gastric cancer (GC) has been less well-defined. Materials and Methods: A retrospective study analyzed the 2007-2016 Surveillance Epidemiology and End Results. GC events were defined as GC-specific deaths; patients without the event were censored at the time of death from other causes or last known follow-up. Late-stage disease was stage III-IV. Insurance status was categorized as "uninsured/Medicaid/private." Five-year survival rates were compared using log-rank tests. Cox regression was used to assess the association between insurance status and GC-specific survival. Logistic regression was used to examine the relationship of insurance status and late-stage disease presentation. Results: Of 5,529 patients, 78.1% were aged ≥50 years; 54.2% were White, 19.4% Hispanic, and 14.0% Black; 73.4% had private insurance, 19.5% Medicaid, and 7.1% uninsured. The 5-year survival was higher for the privately insured (33.9%) than those on Medicaid (24.8%) or uninsured (19.2%) (p<0.001). Patients with Medicaid (adjusted hazard ratio [aHR] 1.22, 95%CI: 1.11-1.33) or uninsured (aHR 1.43, 95%CI: 1.25-1.63) had worse survival than those privately insured. The odds of late-stage disease presentation were higher in the uninsured (adjusted odds ratio [aOR] 1.61, 95%CI: 1.25-2.08) or Medicaid (aOR 1.32, 95%CI: 1.12-1.55) group than those with private insurance. Hispanic patients had greater odds of late-stage disease presentation (aOR 1.35, 95%CI: 1.09-1.66) than Black patients. Conclusions: Findings highlight the need for policy interventions addressing insurance coverage among GC patients and inform screening strategies for populations at risk of late-stage disease.