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The American Journal of Managed Care April 2010
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Age and Rural Residence Effects on Accessing Colorectal Cancer Treatments: A Registry Study

Jayashri Sankaranarayanan, PhD; Shinobu Watanabe-Galloway, PhD; Junfeng Sun, PhD; Fang Qiu, MS, PhD; Eugene C. Boilesen, BS; and Alan G. Thorson, MD

Older patients with colorectal cancer were less likely to undergo surgery, radiation, and chemotherapy; rural patients with colon cancer were less likely to undergo chemotherapy.

Objectives: To test the hypotheses that older patients with colorectal cancer (CRC) and rural patients are less likely to undergo surgery, radiation, and chemotherapy.

 

Study Design: Retrospective study.

 

Methods: A total of 6561 patients with CRC between January 1998 and December 2003 were identified by incident International Classification of Diseases for Oncology codes from the Nebraska Cancer Registry. In multivariate logistic regression analyses, we studied the association of age and residence county (rural vs urban and micropolitan) with each of 3 CRC treatments by anatomic site.

 

Results: After adjusting for patient demographics, insurance payer, ratio of providers to population, and cancer stage, patients with colon cancer living in micropolitan counties were more likely to receive chemotherapy than those living in rural counties (P <.001). Compared with patients aged 19 to 64 years, patients with colon cancer 85 years and older (P <.001) and patients with rectal cancer 75 years and older (P <.05) were less likely to undergo surgery. Patients with CRC 75 years and older were less likely to receive radiation, and patients with colon cancer 65 years and older and patients with rectal cancer 75 years and older were less likely to receive chemotherapy (P <.001 for both).

 

Conclusions: In Nebraska, older patients with CRC were less likely to undergo surgery, radiation, and chemotherapy. Patients with colon cancer in rural counties were less likely to undergo chemotherapy than those in micropolitan counties. Decision makers need to consider issues of age and rural residence in patient access to CRC treatments.

 

(Am J Manag Care. 2010;16(4):265-273)



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