Analysis of Socioeconomic Disparities in Receipt of Adjuvant Chemotherapy in Stage II Colon Cancer: An Inquiry Based on National Cancer Database Open Access

Liang, Wendi (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/rr171x55p?locale=en
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Abstract

This study aimed to first assess whether socioeconomic covariates were predictors of receipt of chemotherapy in stage II colon cancer. Second, for patients who received adjuvant chemotherapy, this study investigated whether there exist predictors for overall survival. As a retrospective study of stage II colon cancer patients in the National Cancer Database, univariate analyses based on ANOVA and Chi-square test and Multivariate analyses using logistic regression and Cox regression models were carried out. Propensity score matching also was adopted in this study to further reduce the selection bias to assess the efficacy of adjuvant chemotherapy. The results demonstrated that socioeconomic factors including age, race, gender, insurance type, facility type, facility location, great circle distance, income and education level were significantly associated with the receipt of adjuvant chemotherapy in stage II colon cancer patients. Other clinical risk factors including tumor size, surgical margins, sequence number, and Charlson-Deyo score were also significantly influencing the receipt of chemotherapy. For patients received postoperative adjuvant chemotherapy, this analysis indicated that socioeconomic factors, such as race, sex, insurance type, living in communities with different income and education attainment were highly associated with the overall survival. Besides, this study confirmed the significant overall survival benefit of chemotherapy in stage II colon cancer.

Table of Contents

1. Introduction................................................................................................... 1

2. Background...................................................................................................... 2

Colon cancer and standard treatments........................................................................................... 2

Adjuvant chemotherapy........................................................................................................................... 3

Factors affect receipt of adjuvant chemotherapy...................................................................... 4

3. Methodology................................................................................................... 5

Data source and study population...................................................................................................... 5

Covariates....................................................................................................................................................... 7

Statistical analysis..................................................................................................................................... 8

4. Results.............................................................................................................. 12

4.1 Aim 1........................................................................................................................................................ 12

4.2 Aim 2........................................................................................................................................................ 16

4.3 Other findings.................................................................................................................................... 17

5. Discussion........................................................................................................ 18

Summary of study & Conclusion........................................................................................................ 18

Limitations................................................................................................................................................... 20

Future research........................................................................................................................................ 20

6. Reference........................................................................................................ 21

7. Appendices...................................................................................................... 25

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