Racial Disparities Exist in Colorectal Cancer Follow-Up Care


National guidelines recommend initial surveillance colonoscopy one year after colorectal cancer surgery, but only 57.5% of patients received one in this study due to racial disparities.

Patients who have undergone colorectal cancer (CRC) surgery must receive an initial surveillance coloscopy at least after one year, but many are unable to due to lack of access across minority racial/ethnic groups, according to a study published in Cancer.

“Based on Andersen’s Behavioral Model of Health Services Use, this study was aimed at assessing the association between patient-and neighborhood-level factors and receipt of surveillance colonoscopy among Medicare beneficiaries,” says the authors.

Using Surveillance, Epidemiology, and End-Results Medicare data from 2009-2014 the researchers followed 6,602 men who received CRC surgery. The men were aged between 66 and 85. Patients must have been enrolled in Medicare Parts A and B one year before their diagnosis.

Andersen’s Behavioral Model of Health Science Use says that individuals receive health based on three factors, or PEN factors. In regard to this study predisposing factors were race/ethnicity, age, sex and marital status. Enabling factors included dual Medicare-Medicaid coverage, median household income (MHI) and urbanization or their neighborhood. Need-based factors included cancer stage at diagnosis, receipt of adjuvant treatment and presence of comorbidities.

An overall total of 57.5% of patients received a colonoscopy within the 18 months of surgery. Of the racial groups analyzed Black people were least likely to receive the colonoscopy at 47.3%, compared to Hispanics at 52.4% and non-Hispanic whites (NHW) at 58.9%. After adjusting for all factors compared to NHW, Hispanics had a 12.9% and Blacks had a 29.6% lower chance of receiving the colonoscopy. The only difference that was statistically significant was between Black patients and NHWs.

The only predisposing factor was that NHW was marriage: males who were unmarried were less likely to receive the colonoscopy. The authors explain this could be linked to a spouse facilitating transportation and social/psychological support.

In regard to enabling factors, NHWs who had dual coverage of Medicare-Medicaid had 35% lower odds of receiving the colonoscopy, compared to NHWs without dual coverage.

Differences by the level of the neighborhood were only detected for Hispanics living in neighborhoods with MHIs of at least $90,001, demonstrating 69% lower odds of receiving a colonoscopy, compared to Hispanics in neighborhoods with MHI’s between $0 and $30,000. The authors explain being Hispanic may contribute to unequal social and cultural conditions.

“For example, neighborhoods enclaves ay influence an induvial health through the quality of local services available, socialization and social networks, peer inclined and physical distance and isolations.”

The only statistically significant need factor found was that NHW’s with stage III CRC had lower odds of surveillance colonoscopy than those with stage III CRC.

Authors say that future studies should build upon this work by adding more years of follow up.

“In conclusion, in a large population-based sample of more than 6,600 Medicare beneficiaries diagnosed with CRC, receipt of initial surveillance colonoscopy remained low, and disparities in surveillance care existed for Black and Hispanic patients with CRC in comparisons with NHW’s,” says the authors.

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