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Non-Adherence to Standard of Care for Locally Advanced Colon Cancer as a Contributory Factor for High Mortality Rates in Kentucky
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4 2020
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Source: J Am Coll Surg. 230(4):428-439
[PDF-660.62 KB]
Details:
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Alternative Title:J Am Coll Surg
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Description:Introduction:
Kentucky has one of the highest mortality rates in colon cancer despite dramatic improvements in screening. The National Comprehensive Cancer Network (NCCN) guidelines recommend surgery 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 non-adherence with current standard of care (SOC) and associated factors as possible contributors to mortality.
Methods:
The Kentucky Cancer Registry (KCR) database linked with administrative health claims was queried for individuals (≥20 years) diagnosed with LACC from 2007–2012. Bivariate and logistic regression of non-adherence was performed. Survival analysis was performed with Cox regression and Kaplan-Meier plots.
Results:
A total of 1404 patients with LACC were included. Approximately 42% of LACC patients were noted to be non-adherent to SOC with nearly all (95.7%) failing to receive adjuvant chemotherapy. After adjusting for all significant factors, we demonstrated factors associated with non-adherence included: age >75 years, stage III colon cancer, high Charlson comorbidity index (CCI 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 non-adherence (63.0% vs 27.4%, respectively, p<0.0001).
Conclusion:
Our study identified multiple factors associated with the failure of LACC patients to receive SOC, particularly adjuvant chemotherapy, suggesting the need to focus on improving adjuvant chemotherapy compliance in specific populations. Non-adherence to LACC SOC is likely a major contributor to the persistently high mortality rates in Kentucky.
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Pubmed ID:32062006
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Pubmed Central ID:PMC9362651
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Volume:230
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Issue:4
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