Are there racial differences in colorectal cancer care timeliness among users of the Veterans Affairs Healthcare System?

Abstract

6555 Background: The Veterans Affairs (VA) healthcare system is the largest integrated healthcare system in the United States. While the quality of VA colorectal cancer (CRC) care is well chronicled, there is a paucity of literature describing racial differences in timeliness of VA CRC care. The objective of this analysis was to examine potential racial differences in CRC care timeliness. Methods: Data were from the VA External Peer Review Program (EPRP), a nationwide VA quality-monitoring program. Included patients must have been Caucasian or African American, diagnosed with non-metastatic CRC between 2003 and 2006, and received definitive CRC surgery. We examined 3 timeliness metrics – time from: 1) surgery to initiation of adjuvant chemotherapy (Stage II-III), 2) surgery to surveillance colonoscopy (Stage I-III), and 3) surgery to death (Stage I-III). Unadjusted analyses used Log-rank and Wilcoxon tests. Adjusted analyses used Cox proportional hazard models. Results: In adjusted Cox regression there were no racial differences in time to initiation of chemotherapy (HR 0.82, p=0.61) or surgery to death (HR 0.94, p=0.0.49). In adjusted Cox regression, Caucasian race was protective, with shorter time to first surveillance colonoscopy (HR 0.63, p=0.02). The median time to colonoscopy was 367 and 383 days for Caucasian and African American patients respectively. Conclusions: Caucasian patients receive follow-up colonoscopies slightly sooner than African American patients in VA; the difference between median times by race is only 16 days. Though statistically significant, this difference is not clinically meaningful since no scientific evidence suggests differing benefits of surveillance colonoscopy in a small timeframe.