Skip to main content

Examining potential cancer care disparities in an equal access system: Quality of colorectal cancer care (CRC) in the Veterans Affairs (VA) health care system.

Publication ,  Journal Article
Carpenter, WR; Abbott, DH; Provenzale, DT; Weinberger, M; Reeve, BB; Jackson, GL
Published in: J Clin Oncol
December 2012

229 Background: Racial disparities in cancer treatment and outcomes are a substantial problem nationally. The Veterans Affairs (VA) health system is nationwide, with goals of being equal access and delivering high-quality care; however, the presence or extent of racial disparities in CRC treatment and outcomes within the VA is poorly understood. We examined the relationship between race and receipt of National Comprehensive Cancer Network guideline-concordant CRC care in the VA. METHODS: We identified 2,896 patients diagnosed with incident CRC between October 1, 2003 and March 31, 2006 from 128 VAMCs. We included white and black patients with invasive, non-metastatic disease, known comorbidity status, age, and marital status. Multivariable logistic regression examined the association between race and receipt of guideline-concordant care (CT scan, preoperative CEA, clear surgical margins, referral to medical oncology for stages II to III; receipt of 5FU-based adjuvant chemotherapy for stage III; receipt of surveillance colonoscopy for stages I-III). Explanatory variables included demographic and disease characteristics. RESULTS: In the final sample of 2,022 men, mean age at diagnosis was 68 years; 85% were white, 52%, married, and 38% lived in the South. Stage was evenly distributed. No significant racial differences existed for most guidelines. Compared to blacks, whites were more likely to undergo surveillance colonoscopy 6 to 18 months following surgery (OR=1.32, 95% CI 1.01-1.73, p=0.04) and marginally more likely to be referred to medical oncology (OR=1.46, 95% CI 1.00-2.13, p=0.05). Patients who were 75 years or older at diagnosis (p<0.01) or with cardiovascular-related comorbidities (OR=0.65, 95% CI 0.50-0.89, p=0.01) were less likely to be referred to a medical oncologist than their younger, healthier counterparts. CONCLUSIONS: In general, the VA provides high quality, equal access cancer care; however, there may be room for improvement.

Duke Scholars

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

December 2012

Volume

30

Issue

34_suppl

Start / End Page

229

Location

United States

Related Subject Headings

  • Oncology & Carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Carpenter, W. R., Abbott, D. H., Provenzale, D. T., Weinberger, M., Reeve, B. B., & Jackson, G. L. (2012). Examining potential cancer care disparities in an equal access system: Quality of colorectal cancer care (CRC) in the Veterans Affairs (VA) health care system. J Clin Oncol, 30(34_suppl), 229. https://doi.org/10.1200/jco.2012.30.34_suppl.229
Carpenter, W. R., D. H. Abbott, D. T. Provenzale, M. Weinberger, B. B. Reeve, and G. L. Jackson. “Examining potential cancer care disparities in an equal access system: Quality of colorectal cancer care (CRC) in the Veterans Affairs (VA) health care system.J Clin Oncol 30, no. 34_suppl (December 2012): 229. https://doi.org/10.1200/jco.2012.30.34_suppl.229.
Carpenter WR, Abbott DH, Provenzale DT, Weinberger M, Reeve BB, Jackson GL. Examining potential cancer care disparities in an equal access system: Quality of colorectal cancer care (CRC) in the Veterans Affairs (VA) health care system. J Clin Oncol. 2012 Dec;30(34_suppl):229.
Carpenter, W. R., et al. “Examining potential cancer care disparities in an equal access system: Quality of colorectal cancer care (CRC) in the Veterans Affairs (VA) health care system.J Clin Oncol, vol. 30, no. 34_suppl, Dec. 2012, p. 229. Pubmed, doi:10.1200/jco.2012.30.34_suppl.229.
Carpenter WR, Abbott DH, Provenzale DT, Weinberger M, Reeve BB, Jackson GL. Examining potential cancer care disparities in an equal access system: Quality of colorectal cancer care (CRC) in the Veterans Affairs (VA) health care system. J Clin Oncol. 2012 Dec;30(34_suppl):229.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

December 2012

Volume

30

Issue

34_suppl

Start / End Page

229

Location

United States

Related Subject Headings

  • Oncology & Carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences