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research
Comorbidity, age, race and stage at diagnosis in colorectal cancer: a retrospective, parallel analysis of two health systems
Authors
A Hawfield
A Jemal
+59 more
AI Neugent
AK Jha
Amy P Abernethy
AP Abernethy
Colorectal Cancer Collaborative Group
CP Gross
DA Fisher
David H Abbott
Dawn T Provenzale
DP Cronin
E Ward
EA Kerr
EC Gonzalez
EZ Oddone
GS Cooper
HK Sanoff
J Crawford
J Ferlay
JA Dominitz
James E Herndon
Jane T Kolimaga
Jennifer E Marcello
JJ Griggs
JM Geraci
JR Ouellette
JZ Ayanian
KM Nelson
Krista L Rowe
KS Garman
Leah L Zullig
LL Adams-Campbell
M Shayne
ME Charlson
Meenal B Patwardhan
MF De Marco
MS Aapro
MT Halpern
NC Dolan
NJ Wilson
P Seve
PB Bach
R Berardi
R Luo
RA Deyo
RF Galbraith
RM Goldberg
S Firat
S Ong
S Subramanian
S Sultan
S Yousuf Zafar
SD Ramsey
SF Hall
ST Fleming
Steven C Grambow
T Anthony
VE Lemmens
W Demark-Wahnefried
YX Yang
Publication date
1 January 2008
Publisher
'Springer Science and Business Media LLC'
Doi
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PubMed
Abstract
© 2008 Zafar et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background : Stage at diagnosis plays a significant role in colorectal cancer (CRC) survival. Understanding which factors contribute to a more advanced stage at diagnosis is vital to improving overall survival. Comorbidity, race, and age are known to impact receipt of cancer therapy and survival, but the relationship of these factors to stage at diagnosis of CRC is less clear. The objective of this study is to investigate how comorbidity, race and age influence stage of CRC diagnosis. Methods : Two distinct healthcare populations in the United States (US) were retrospectively studied. Using the Cancer Care Outcomes Research and Surveillance Consortium database, we identified CRC patients treated at 15 Veterans Administration (VA) hospitals from 2003–2007. We assessed metastatic CRC patients treated from 2003–2006 at 10 non-VA, fee-for-service (FFS) practices. Stage at diagnosis was dichotomized (non-metastatic, metastatic). Race was dichotomized (white, non-white). Charlson comorbidity index and age at diagnosis were calculated. Associations between stage, comorbidity, race, and age were determined by logistic regression. Results : 342 VA and 340 FFS patients were included. Populations differed by the proportion of patients with metastatic CRC at diagnosis (VA 27% and FFS 77%) reflecting differences in eligibility criteria for inclusion. VA patients were mean (standard deviation; SD) age 67 (11), Charlson index 2.0 (1.0), and were 63% white. FFS patients were mean age 61 (13), Charlson index 1.6 (1.0), and were 73% white. In the VA cohort, higher comorbidity was associated with earlier stage at diagnosis after adjusting for age and race (odds ratio (OR) 0.76, 95% confidence interval (CI) 0.58–1.00; p = 0.045); no such significant relationship was identified in the FFS cohort (OR 1.09, 95% CI 0.82–1.44; p = 0.57). In both cohorts, no association was found between stage at diagnosis and either age or race. Conclusion : Higher comorbidity may lead to earlier stage of CRC diagnosis. Multiple factors, perhaps including increased interactions with the healthcare system due to comorbidity, might contribute to this finding. Such increased interactions are seen among patients within a healthcare system like the VA system in the US versus sporadic interactions which may be seen with FFS healthcare
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