Disparities in CRC post-treatment surveillance: An explanation for mortality differences between black and white CRC patients Free

B53


 Introduction:
 CRC post-treatment surveillance recommendations indicate the need for frequent regular follow-up using colonoscopy to identify clinically significant cancers. A recent Cochrane review indicates that there is an overall survival benefit for intensifying the follow-up of patients after curative surgery for colorectal cancer. Not all patients receive surveillance according to current guidelines, when considering either specified frequency or timing. Several studies indicate that Black patients are less likely to receive post-treatment CRC surveillance compared to white patients, even true among insured participants and especially true among Black elderly patients. We will use a model called the Systems Model of Clinical Preventive Care, to shape the proposed study’s assessments.
 Methodology:
 Boston Medical Center (BMC) is a private, not for profit, 547-licensed bed academic medical center with the mission to provide consistently accessible health services to all, making it the largest provider of free care in New England, serving a racially/ethnically and socioeconomically diverse urban patient population. To identify potential participants, we accessed the data warehouse housed within the clinical data warehouse, merging demographic, clinical, medical, and social data.
 Results:
 A total of 938 patients with a colorectal cancer diagnosis were treated over the 10 year study period at BMC. Fifty-two percent of these patients were men and 300 of these patients were African-American. Our preliminary descriptive analyses of African American colorectal cancer patients’ frequency of colonoscopies showed great variation in surveillance. More than half of these patients (58%) did NOT receive a colonoscopy after their diagnosis. Only 17 percent of patients received the recommended follow-up colonoscopy within 12 months of diagnosis. Forty-one percent of patients were followed-up with a colonoscopy, yet these patients’ surveillance occurred delayed, after the recommended 12 months since diagnosis.
 Analysis include logistic regression using surveillance of any type an surveillance according to guidelines as dependent variables, and the clusters of variables from the Systems Model of Clinical Preventive Care as independent variables.
 Conclusions:
 To date, few analyses have provided reasons for differences in surveillance behaviors between Black and White colorectal cancer patients. Once identified, these reasons can be used to design intervention opportunities to reduce disparities and increase surveillance in black patients.