Surgery and adjuvant chemotherapy use among veterans with colon cancer: Insights from a California study

Denise M. Hynes, Elizabeth Tarlov, Ramon Durazo-Arvizu, Ruth Perrin, Qiuying Zhang, Thomas Weichle, M. Rosario Ferreira, Todd Lee, Al B. Benson, Nirmala Bhoopalam, Charles L. Bennett

Research output: Contribution to journalArticle

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Abstract

Purpose: US veterans have been shown to be a vulnerable population with high cancer rates, and cancer care quality in Veterans Affairs (VA) hospitals is the focus of a congressionally mandated review. We examined rates of surgery and chemotherapy use among veterans with colon cancer at VA and non-VA facilities in California to gain insight into factors associated with quality of cancer care. Methods: A retrospective cohort of incident colon cancer patients from the California Cancer Registry, who were ≥ 66 years old and eligible to use VA and Medicare between 1999 and 2001, were observed for 6 months after diagnosis. Results: Among 601 veterans with colon cancer, 72% were initially diagnosed and treated in non-VA facilities. Among veterans with stage I to III cancer, those diagnosed and initially treated in VA facilities experienced similar colectomy rates as those at non-VA facilities. Stage III patients diagnosed and initially treated in VA versus non-VA facilities had similar odds of receiving adjuvant chemotherapy. In both settings, older patients had lower odds of receiving chemotherapy than their younger counterparts even when race and comorbidity were considered (age 76 to 85 years: odds ratio [OR] = 0.18; 95% CI, 0.07 to 0.46; age ≥ 86 years: OR = 0.17; 95% CI, 0.04 to 0.73). Conclusion: In California, older veterans with colon cancer used both VA and non-VA facilities for cancer treatment, and odds of receiving cancer-directed surgery and chemotherapy were similar in both systems. Among stage III patients, older age lowered odds of receiving adjuvant chemotherapy in both systems. Further studies should continue to explore potential health system effects on quality of colon cancer care across the United States.

Original languageEnglish (US)
Pages (from-to)2571-2576
Number of pages6
JournalJournal of Clinical Oncology
Volume28
Issue number15
DOIs
StatePublished - May 20 2010

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Veterans
Adjuvant Chemotherapy
Colonic Neoplasms
Neoplasms
Quality of Health Care
Drug Therapy
Odds Ratio
Veterans Hospitals
Colectomy
Vulnerable Populations
Medicare
Registries
Comorbidity
Health

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Hynes, D. M., Tarlov, E., Durazo-Arvizu, R., Perrin, R., Zhang, Q., Weichle, T., ... Bennett, C. L. (2010). Surgery and adjuvant chemotherapy use among veterans with colon cancer: Insights from a California study. Journal of Clinical Oncology, 28(15), 2571-2576. https://doi.org/10.1200/JCO.2009.23.5200
Hynes, Denise M. ; Tarlov, Elizabeth ; Durazo-Arvizu, Ramon ; Perrin, Ruth ; Zhang, Qiuying ; Weichle, Thomas ; Ferreira, M. Rosario ; Lee, Todd ; Benson, Al B. ; Bhoopalam, Nirmala ; Bennett, Charles L. / Surgery and adjuvant chemotherapy use among veterans with colon cancer : Insights from a California study. In: Journal of Clinical Oncology. 2010 ; Vol. 28, No. 15. pp. 2571-2576.
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abstract = "Purpose: US veterans have been shown to be a vulnerable population with high cancer rates, and cancer care quality in Veterans Affairs (VA) hospitals is the focus of a congressionally mandated review. We examined rates of surgery and chemotherapy use among veterans with colon cancer at VA and non-VA facilities in California to gain insight into factors associated with quality of cancer care. Methods: A retrospective cohort of incident colon cancer patients from the California Cancer Registry, who were ≥ 66 years old and eligible to use VA and Medicare between 1999 and 2001, were observed for 6 months after diagnosis. Results: Among 601 veterans with colon cancer, 72{\%} were initially diagnosed and treated in non-VA facilities. Among veterans with stage I to III cancer, those diagnosed and initially treated in VA facilities experienced similar colectomy rates as those at non-VA facilities. Stage III patients diagnosed and initially treated in VA versus non-VA facilities had similar odds of receiving adjuvant chemotherapy. In both settings, older patients had lower odds of receiving chemotherapy than their younger counterparts even when race and comorbidity were considered (age 76 to 85 years: odds ratio [OR] = 0.18; 95{\%} CI, 0.07 to 0.46; age ≥ 86 years: OR = 0.17; 95{\%} CI, 0.04 to 0.73). Conclusion: In California, older veterans with colon cancer used both VA and non-VA facilities for cancer treatment, and odds of receiving cancer-directed surgery and chemotherapy were similar in both systems. Among stage III patients, older age lowered odds of receiving adjuvant chemotherapy in both systems. Further studies should continue to explore potential health system effects on quality of colon cancer care across the United States.",
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Hynes, DM, Tarlov, E, Durazo-Arvizu, R, Perrin, R, Zhang, Q, Weichle, T, Ferreira, MR, Lee, T, Benson, AB, Bhoopalam, N & Bennett, CL 2010, 'Surgery and adjuvant chemotherapy use among veterans with colon cancer: Insights from a California study', Journal of Clinical Oncology, vol. 28, no. 15, pp. 2571-2576. https://doi.org/10.1200/JCO.2009.23.5200

Surgery and adjuvant chemotherapy use among veterans with colon cancer : Insights from a California study. / Hynes, Denise M.; Tarlov, Elizabeth; Durazo-Arvizu, Ramon; Perrin, Ruth; Zhang, Qiuying; Weichle, Thomas; Ferreira, M. Rosario; Lee, Todd; Benson, Al B.; Bhoopalam, Nirmala; Bennett, Charles L.

In: Journal of Clinical Oncology, Vol. 28, No. 15, 20.05.2010, p. 2571-2576.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Surgery and adjuvant chemotherapy use among veterans with colon cancer

T2 - Insights from a California study

AU - Hynes, Denise M.

AU - Tarlov, Elizabeth

AU - Durazo-Arvizu, Ramon

AU - Perrin, Ruth

AU - Zhang, Qiuying

AU - Weichle, Thomas

AU - Ferreira, M. Rosario

AU - Lee, Todd

AU - Benson, Al B.

AU - Bhoopalam, Nirmala

AU - Bennett, Charles L.

PY - 2010/5/20

Y1 - 2010/5/20

N2 - Purpose: US veterans have been shown to be a vulnerable population with high cancer rates, and cancer care quality in Veterans Affairs (VA) hospitals is the focus of a congressionally mandated review. We examined rates of surgery and chemotherapy use among veterans with colon cancer at VA and non-VA facilities in California to gain insight into factors associated with quality of cancer care. Methods: A retrospective cohort of incident colon cancer patients from the California Cancer Registry, who were ≥ 66 years old and eligible to use VA and Medicare between 1999 and 2001, were observed for 6 months after diagnosis. Results: Among 601 veterans with colon cancer, 72% were initially diagnosed and treated in non-VA facilities. Among veterans with stage I to III cancer, those diagnosed and initially treated in VA facilities experienced similar colectomy rates as those at non-VA facilities. Stage III patients diagnosed and initially treated in VA versus non-VA facilities had similar odds of receiving adjuvant chemotherapy. In both settings, older patients had lower odds of receiving chemotherapy than their younger counterparts even when race and comorbidity were considered (age 76 to 85 years: odds ratio [OR] = 0.18; 95% CI, 0.07 to 0.46; age ≥ 86 years: OR = 0.17; 95% CI, 0.04 to 0.73). Conclusion: In California, older veterans with colon cancer used both VA and non-VA facilities for cancer treatment, and odds of receiving cancer-directed surgery and chemotherapy were similar in both systems. Among stage III patients, older age lowered odds of receiving adjuvant chemotherapy in both systems. Further studies should continue to explore potential health system effects on quality of colon cancer care across the United States.

AB - Purpose: US veterans have been shown to be a vulnerable population with high cancer rates, and cancer care quality in Veterans Affairs (VA) hospitals is the focus of a congressionally mandated review. We examined rates of surgery and chemotherapy use among veterans with colon cancer at VA and non-VA facilities in California to gain insight into factors associated with quality of cancer care. Methods: A retrospective cohort of incident colon cancer patients from the California Cancer Registry, who were ≥ 66 years old and eligible to use VA and Medicare between 1999 and 2001, were observed for 6 months after diagnosis. Results: Among 601 veterans with colon cancer, 72% were initially diagnosed and treated in non-VA facilities. Among veterans with stage I to III cancer, those diagnosed and initially treated in VA facilities experienced similar colectomy rates as those at non-VA facilities. Stage III patients diagnosed and initially treated in VA versus non-VA facilities had similar odds of receiving adjuvant chemotherapy. In both settings, older patients had lower odds of receiving chemotherapy than their younger counterparts even when race and comorbidity were considered (age 76 to 85 years: odds ratio [OR] = 0.18; 95% CI, 0.07 to 0.46; age ≥ 86 years: OR = 0.17; 95% CI, 0.04 to 0.73). Conclusion: In California, older veterans with colon cancer used both VA and non-VA facilities for cancer treatment, and odds of receiving cancer-directed surgery and chemotherapy were similar in both systems. Among stage III patients, older age lowered odds of receiving adjuvant chemotherapy in both systems. Further studies should continue to explore potential health system effects on quality of colon cancer care across the United States.

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