routine preventive care and cancer surveillance in long-term survivors (lts) of colorectal cancer:...
DESCRIPTION
Long-Term Survivors Growing population of Long-Term Survivors (LTS) of Colorectal Cancer 10% of 11.1 million cancer survivors in US Little known about LTS use of: Routine Preventive Care Cancer Screening Cancer SurveillanceTRANSCRIPT
Routine Preventive Care and Cancer Surveillance in Long-
Term Survivors (LTS) of Colorectal Cancer:
Results from NSABP Protocol LTS-01
Hiroko Kunitake MD1, Ping Zheng MD MS2, Greg Yothers PhD2, Stephanie Land PhD2
Louis Fehrenbacher MD3, Jeffrey Giguere MD4, D.Lawrence Wickerham MD2
Patricia A. Ganz MD1, Clifford Y. Ko MD MSHS1
1David Geffen School of Medicine at UCLA; 2NSABP Operations and Biostatistics Center, University of Pittsburgh; 3Kaiser Permanente
Medical Center, Vallejo, CA4Cancer Center of the Carolinas
Disclosures
• We have no disclosures
Long-Term Survivors
• Growing population of Long-Term Survivors (LTS) of Colorectal Cancer 10% of 11.1 million cancer survivors in
US
• Little known about LTS use of: Routine Preventive Care Cancer Screening Cancer Surveillance
How do you identify LTS?
• Difficulty in gathering consistent LTS study cohort
• Previous studies used Cancer Registries
• Possibility of gathering study cohort from Colorectal cancer clinical trials
NSABP LTS-01 Study
Aims
1. Characterize LTS-01 Routine Preventive Care Comparison with non-cancer general population
2. Determine LTS-01 rates of Cancer Screening Comparison with non-cancer general population
3. Evaluate LTS-01 Cancer Surveillance
Methods • LTS-01 Cohort
Recruited from 60 NSABP study sites Participated in C-05, C-06, C-07, R-02, R-
03 5+ year survival Received computer assisted telephone
interview (CATI)
NSABP Participating Sites
Methods
Methods • LTS-01 Cohort
Recruited from 60 NSABP study sites Participated in C-05, C-06, C-07, R-02, R-
03 5+ year survival Received computer assisted telephone
interview (CATI)
Years of Treatment Trial Accrual
C-07
Methods
Methods • LTS-01 Cohort
Recruited from 60 NSABP study sites Participated in C-05, C-06, C-07, R-02, R-03 5+ year survival Received computer assisted telephone
interview (CATI)• Control non-cancer cohort
National Health Interview Survey (NHIS) 2005 3:1 case-matched Matched on age, gender, race, education
Analysis
1. Routine Preventive Care of LTS-01 and NHIS Usual Source of Care, ER visits, Flu
shot
2. Cancer Screening of LTS-01 and NHIS Mammogram, Pap smear, PSA test
3. Cancer Surveillance of LTS-01 patients Colonoscopy, CEA test, CT scan
Methods
Analysis
• Comparison of LTS-01 and NHIS samples:Fisher’s Exact Test
• Predictors of Receipt of Care: Logistic Regression Models
Routine Preventive Care Cancer Screening Cancer Surveillance
Methods
LTS-01 Recruitment Results
Total eligible patients
2,408Patients
contacted976
Patients not interested
232Did not complete
interview36
Completed interview
708
Patients interested
744
LTS-01 Recruitment Results
Total eligible patients
2,408Patients
contacted976
Patients not interested
232Did not complete
interview36
Completed interview
708
Patients interested
744
LTS-01 Participants • Colon cancer trials Patients
C-05 147 C-06 180 C-07 354
• Rectal cancer trials R-02 15 R-03 12
Total: 708 patients
LTS-01 Participation Rates
DemographicsVariables LTS-01
N= 708NHIS
N= 2124Gender Male 57.1% 57.1%Age (in years) <50 50-59 60-69 ≥70
7.3%19.8%32.1%40.8%
7.3%19.8%32.1%40.8%
Race Black Other
2.7%97.3%
2.7%97.3%
HispanicYesNo
3.8%96.2%
10.2%89.8%
DemographicsVariables LTS-01
N= 708NHIS
N= 2124 p-value
Education Less than high schoolHigh school graduateCollegePost graduate
6.2%53.5%21.8%18.5%
21.1%38.7%22.0%18.3%
<0.0001
Married 75.9% 54.6% <0.0001
Health insurance 99.0% 93.3% <0.0001
Private insurance 76.1% 66.5% <0.0001
LTS-01 and NHIS Comorbidities
Health Behaviors
Health Behavior LTS-01N= 708
NHISN= 2124 p-value
Have a usual source of care 97.7% 93.8% <0.0001
ER visits in past 12 months None One Two or more
78.0%14.4%7.6%
80.6%13.7%5.7%
0.1619
Had flu shot in past 12 months 67.5% 44.3% <0.0001
Factors associated with Usual Source of Care
Predictors Odds Ratio
95% WaldConfidence
Limitsp-value
Health insurance 7.55 4.47 to 12.73 < 0.0001
Diabetes 6.70 2.42 to 18.53 0.0002
Private insurance 2.11 1.35 to 3.31 0.0010
LTS-01 1.79 1.04 to 3.09 0.0369
Age 1.33 1.10 to 1.62 0.0039
Male 0.67 0.46 to 0.97 0.0328
Factors Associated with Flu Shot
Predictors Odds Ratio
95% WaldConfidence
Limitsp-value
Health Insurance 2.99 1.84 to 4.85 <0.0001
LTS-01 2.88 2.35 to 3.53 <0.0001
Age 2.32 2.10 to 2.57 <0.0001
Diabetes 2.23 1.74 to 2.86 <0.0001 Heart disease 1.76 1.36 to 2.28 <0.0001
Lung disease 1.52 1.18 to 1.96 0.0011
Education 1.14 1.04 to 1.25 0.0040
Male 0.74 0.63 to 0.89 0.0009
Hispanic 0.67 0.49 to 0.92 0.0140
Cancer Screening
Screening Test LTS-01 NHIS p-value
PAP smear in past 12 months* 67.3% 54.8% <0.0001
Mammogram in past 12 months* 84.4% 70.7% <0.0001
PSA test in past 12 months# 84.5% 74.5% <0.0001
* Women only # Men only
LTS-01 Cancer Surveillance
Surveillance Test Percent
Colonoscopy In last 2 years In last 5 years
74.1%96.5%
Carcinoembryonic Antigen Test In last 2 years In last 5 years
71.8%88.0%
Computed Tomography Scan In last 2 years In last 5 years
43.9%66.4%
LTS-01 Cancer Surveillance and Survivorship
Summary
• LTS-01 patients More usual source of care Higher rates of flu shot More cancer screening High rates of cancer surveillance
• Highly motivated LTS-01 patients
Limitations• Selective participation of LTS-01 patients
• Variation in length of survival among cancer trials
• Nationally representative sample of CRC survivors
• Ability to link cancer treatment to late effects
Strengths
Implications
• Clinical trials as a source of long-term survivor information
• Further results of LTS-01 patient-reported outcomes to follow
Extra slides
Factors Associated with ER Use
Predictors Odds Ratio
95% WaldConfidence
Limitsp-value
LTS-01 1.18 0.95 to 1.47 0.1298
Education 0.87 0.79 to 0.95 0.0037
Heart Disease 1.40 1.09 to 1.80 0.0079
Stroke 1.92 1.39 to 2.65 <0.0001
Chronic Lung Disease 1.57 1.22 to 2.01 0.0005
Diabetes 1.28 1.00 to 1.64 0.0464
Kidney Disease 1.47 0.99 to 2.17 0.0573
Bowel Disease 1.61 1.21 to 2.15 0.0011
Cancer Screening by Age: Pap smear
Cancer Screening by Age: Mammogram
Cancer Screening by Age: PSA test