Journal article
Social Vulnerability and Receipt of Guideline-Concordant Care among Patients with Colorectal Cancer
Journal of the American College of Surgeons, Vol.240(2), pp.167-178
02/2025
DOI: 10.1097/XCS.0000000000001193
PMID: 39297529
Abstract
Background: Cancer outcome disparities have been reported in highly vulnerable communities. The objective of this study was to evaluate the association of social vulnerability with receipt of guideline-concordant care (GCC) and mortality risk for patients with colorectal cancer. Study Design: This retrospective observational study identified patients with stage I-III colon or stage II-III rectal cancer between 2018 and 2020 from the National Program of Cancer Registries Database. Data were merged with the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) at the county level. GCC was defined as stage-appropriate lymphadenectomy, radiation therapy, or systemic therapy. Multivariable logistic regression and Cox proportional hazards regression investigated associations of SVI, as a continuous and categorical variable stratified into quartiles, with GCC and 3-year cancer-specific mortality risk, respectively. Results: Among 124,950 patients (colon, n=102,399; rectal, n=22,551), median SVI was 60.9 (IQR 35.0 to 79.5). Patients in the highest SVI quartile had 21% decreased odds of receiving GCC (95% CI 0.76 – 0.83). Treatment at Commission on Cancer (CoC) accredited hospitals was associated with increased GCC (OR 1.79; 95% CI 1.72 – 1.85). Although there was an inverse, decreasing association between SVI and probability of GCC, probability at non-CoC-accredited hospitals declined faster than at CoC-accredited hospitals (p<0.05). After adjusting for receipt of GCC, highly vulnerable patients treated at CoC-accredited hospitals had decreased mortality risk (HR 0.91; 95% CI 0.83 – 0.98). Conclusion: For highly vulnerable patients, treatment at CoC-accredited hospitals was associated with increased receipt of GCC and decreased mortality risk, which may reflect CoC-accreditation requirements for treatment guideline adherence, community engagement, and addressing barriers to care.
Details
- Title: Subtitle
- Social Vulnerability and Receipt of Guideline-Concordant Care among Patients with Colorectal Cancer
- Creators
- Kelley Chan - Loyola University ChicagoBryan E Palis - American College of SurgeonsJoseph H Cotler - American College of SurgeonsLauren M Janczewski - American College of SurgeonsRonald J Weigel - University of IowaClifford Y Ko - University of California, Los AngelesDavid J Bentrem - Northwestern University
- Resource Type
- Journal article
- Publication Details
- Journal of the American College of Surgeons, Vol.240(2), pp.167-178
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- DOI
- 10.1097/XCS.0000000000001193
- PMID
- 39297529
- ISSN
- 1072-7515
- eISSN
- 1879-1190
- Grant note
- American College of Surgeons Clinical Scholars in Residence Program
Support: Dr Chan is supported by the American College of Surgeons Clinical Scholars in Residence Program Grant.
- Language
- English
- Electronic publication date
- 09/19/2024
- Date published
- 02/2025
- Academic Unit
- Molecular Physiology and Biophysics; Anatomy and Cell Biology; Surgery; Biochemistry and Molecular Biology
- Record Identifier
- 9984719236602771
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