Predictors of Adherence to Standard Treatment Guidelines for Stage III Colon Cancer among Patients in Georgia from 2002-2005 Open Access

Abstract

Quality of colon cancer care remains problematic in the United States. National Quality Forum (NQF) endorsed quality metrics have been commonly utilized with population-based cancer registry data to assess the quality of care. However, one of the major limitations is the extent of information for quality measure assessment captured by registry data. Our augmenting study used four bilateral linkages of Georgia cancer registry data to Medicare, Medicaid, State Health Benefit Plan of Georgia (SHBPG) and Kaiser Permanente of Georgia (KPG) claims, to more completely assess factors predicting receipt of adjuvant chemotherapy within 4 months of diagnosis for patients under the age of 80 with AJCC Stage III colon cancer in Georgia from 2002-2005 and measure overall adherence to this guideline. We found 70 percent (761/1086) concordance and 30 percent (325/1086) discordance in receipt of chemotherapy between the registry data and combination of claims data from four sources. Older age was found to be a significant predictor of less receipt of chemotherapy among stage III colon cancer patients in Georgia (66-72 years vs. <=65 years: adjusted OR = 0.619, 95% CI: 0.393, 0.974; 73-79 years vs. <=65 years: adjusted OR = 0.306, 95% CI: 0.200, 0.467). In contrast, being married (adjusted OR = 1.663, 95% CI: 1.151, 2.402) and having four or more positive regional nodes (adjusted OR = 1.642, 95% CI: 1.069, 2.520) were found to significantly predict receipt of chemotherapy. Linkage of cancer registry data with insurance claims data is an effective method for augmenting missing treatment data in population-based cancer registries and better quality assessment. In addition, quality improvement of colon cancer care in Georgia should target more vulnerable populations for higher efficiency.

Table of Contents

Introduction 1

Literature Review 2

Colorectal Cancer 2

Treatments for Colon Cancer 4

Quality Issues of Colorectal Cancer Care 4

Disparities in Receipt of Standard Treatment - Adjuvant Chemotherapy 6

Quality Measurement Based on Adjuvant Chemotherapy 7

Methods 9

Data Source 9

Quality Measure 9

Predictors 10

Analysis 12

Results 13

Discussion 17

Agreement and Disagreement between Registry Data and Claims Data 17

Predictors for Receipt of Standard Care 18

Strengths and Limitations 20

Future Recommendations and Research 21

References 22

Tables 29

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	Quality of care Colon cancer
Committee Chair / Thesis Advisor	Ward, Kevin C., Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Georgia state or local health department

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