Abstract
Abstract BACKGROUND: The objective of the current study was to examine the impact of payer status on relative survival outcomes in colon cancer patients. METHODS: A population-based analysis of National Cancer Data Bank (NCDB) records for invasive colon cancer was done using data from patients diagnosed between 1998 and 2006 and followed up to 2011. The cohort consisted of colon cancer patients of analytic stage I to stage IV. Information regarding age, race, gender, stage of cancer at the time of diagnosis, year of diagnosis, insurance status, income, treatment received and diagnostic facility, and type of treating facility were included in this study. Age, sex, race, calendar year specific US life table between 1970 and 2007 were used to compute expected survival. Multivariate Poisson modeling was used to estimate relative survival for payer status adjusting for other factors. RESULTS: 436,235 colon cancer patients who met the inclusion criteria were included in the study. The mean age at diagnosis was 68.9 years. The stage distribution among the variables listed above is statistically significant. The 5-year cumulative relative survivals are 0.76, 0.84, 0.93, 1.74 and 1.10 for uninsured, Medicaid, private insurance, Medicare, and unknown payer status respectively. In multivariate analysis of relative survival, adjusting for other factors, the excess hazard ratios (EHR) were 1.74, 1.14, 0.89 and 1.29 for uninsured, Medicaid, Medicare, and unknown payer status versus private insurance respectively (P<0.05). The EHRs for blacks and other races versus whites were 1.07 and 1.53 respectively (p<0.05). The EHRs for follow-up year of 2, 3, 4, 5 versus year 1 were 1.17, 0.21, 0.18, and 0.54 respectively (P <0.05). Compared to academic/research program facility type, the EHRs for community cancer program, comprehensive community cancer program, and other specified types of cancer programs were 1.02,0.77 and 25.9 respectively (P <0.05). The relative survival rates for stage II, III, IV versus stage I were 0.95, 0.82, and 0.70 respectively (P<0.05). Diagnosis before or after 2002 and the type of treatment facility lead to a marginal difference in the relative survival. CONCLUSIONS: Our study shows the impact of payer status on the relative survival of patients with colon cancer and demonstrated increased mortality for uninsured patients in contrast to survival benefit for patients with Medicare and private insurance. Citation Format: Srinivas S. Devarakonda, Runhua Shi, Amarendra Neppalli, Glenn Mills. Disparities in colon cancer survival according to payer status: Findings from national cancer data bank. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4133. doi:10.1158/1538-7445.AM2014-4133
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