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Research ArticleOriginal Research

Receipt of General Medical Care by Colorectal Cancer Patients: A Longitudinal Study

Laura-Mae Baldwin, Sharon A. Dobie, Yong Cai, Barry G. Saver, Pamela K. Green and C. Y. Wang
The Journal of the American Board of Family Medicine January 2011, 24 (1) 57-68; DOI: https://doi.org/10.3122/jabfm.2011.01.100080
Laura-Mae Baldwin
MD, MPH
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Sharon A. Dobie
MCP, MD
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Yong Cai
PhD
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Barry G. Saver
MD, MPH
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Pamela K. Green
MPH, PhD
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C. Y. Wang
PhD
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    Figure 1.

    Study care phases.

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    Figure 2.

    Adjusted relative risk of influenza vaccination, mammography, and diabetes care measures (hemoglobin A1c and lipid testing) by cancer/control status and phase. Adjusted for the following variables: age, sex (when applicable), race ethnicity, median annual household income in ZIP code percent of those ≥25 years old who graduated from high school in zip code, reason for Medicare, National Cancer Institue combined comorbidity index, and number of hospitalizations. Note that relative risk scales differ for each measure.

Tables

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    Table 1.

    Number of Persons in Each Study Observation Year by Study Group

    TotalCRC CasesControls
    Stage 0–1Stage 2–3
    Year before prediagnosis phase (year −2)103,8308,86513,29681,669
    Phase before diagnosis (year −1)103,8308,86513,29681,669
    Phase after initial treatment (year 1)103,8308,86513,29681,669
    Surveillance phase
        Year 288,8597,54810,67970,632
        Year 367,9595,5737,67254,714
        Year 450,1594,0825,36640,711
    Survival phase
        Year 535,1342,8253,57528,734
        Year 622,6351,7912,24018,604
        Year 712,2629911,14010,131
    • CRC, colorectal cancer.

    • View popup
    Table 2.

    Characteristics of Initial Study Population by Study Group

    CRC CasesControls (n = 81,669)
    Stage 0–1 (n = 8,865)Stage 2–3 (n = 13,296)
    Age, years*
        67–6915.613.819.5
        70–7429.427.532.3
        75–7928.027.525.1
        80–8927.131.223.1
    Female*53.956.662.8
    Race/ethnicity*
        White86.687.284.8
        Asian3.53.33.8
        Black6.36.16.6
        Hispanic1.01.12.2
        Other2.62.32.7
    National Cancer Institute combined comorbidity index during the phase before diagnosis year*
        ≤071.774.776.1
        >0–0.514.613.512.4
        >0.5–1.08.17.57.4
        >1.05.64.44.1
    Hospitalizations during the phase before diagnosis year†
        085.386.986.6
        111.110.110.1
        22.62.12.4
        30.80.60.6
        40.20.30.2
        ≥50.10.10.1
    Annual visits to cancer care physicians (mean [SD])‡
        Phase after initial treatment*1.4 (3.2)4.6 (7.1)0.3 (1.4)
        Surveillance phase*0.7 (1.7)1.3 (2.1)0.3 (1.4)
        Survival phase*0.5 (1.5)0.8 (1.6)0.4 (1.5)
    Visits to noncancer care physicians during the phase before diagnosis year*
        ≤742.650.050.1
        8–1533.030.229.2
        16–2516.614.214.2
        >257.85.66.5
    Reason for Medicare eligibility§
        Age ≥65 years94.194.793.9
        Disability/end-stage renal disease5.95.36.1
    Percent of those ≥25 years old who graduated from high school in ZIP code*‖
        0–501.71.72.1
        50–7516.016.217.6
        75–9054.854.552.2
        >9027.627.728.1
    Median annual household income in ZIP code*‖
        ≤$30,0008.28.610.3
        >$30,000–45,00038.439.038.2
        >$45,00053.452.451.5
    • Values provided as % unless otherwise specified.

    • * P ≤ .001.

    • † P ≤ .05.

    • ‡ Cancer care physicians include general surgeons, colorectal surgeons, medical oncologists, radiation oncologists.

    • § P ≤ .01.

    • ‖ Missing values: people ≥25 years old who graduated from high school in ZIP code (%): stage 0–1, n = 207 (2.3%); stage 2–3, n = 300 (2.3%); controls, n = 2274 (2.8%); median annual household income in ZIP code: stage 0–1, n = 210 (2.4%); stage 2–3, n = 301 (2.3%); controls, n = 2286 (2.8%).

    • CRC.

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    Table 3.

    Unadjusted Annual Rates of Influenza Vaccination, Mammography, and Diabetes Care Measures by Cancer/Control Status and Year/Phase

    Observation YearPhase before DiagnosisPhase after Initial TreatmentSurveillance PhaseSurvival Phase
    −11234567
    Influenza vaccination*
        Stage 0–1 CRC cases†50.9 (49.6–52.1)53.2 (52.0–54.4)53.9 (52.5–55.3)51.9 (50.2–53.6)52.6 (49.5–53.7)52.4 (49.5–55.3)52.5 (47.0–58.0)
        Stage 2–3 CRC cases‡46.4 (45.4–47.4)50.2 (49.1–51.2)49.9 (48.7–51.1)49.3 (47.8–50.8)47.5 (45.5–49.4)49.2 (46.5–51.9)51.1 (46.2–56.0)
        Controls§46.1 (45.7–46.5)47.0 (46.6–47.4)47.6 (47.1–48.0)48.0 (47.4–48.5)48.1 (47.4–48.7)45.9 (45.0–46.8)48.3 (46.7–49.9)
    Mammography‖
        Stage 0–1 CRC cases¶41.6 (39.1–44.1)45.0 (42.5–47.5)43.6 (40.7–46.6)48.0 (44.3–51.8)49.6 (44.7–54.5)52.4 (44.7–58.2)52.4 (41.7–63.1)50.0 (25.5–74.5)
        Stage 2–3 CRC cases**31.4 (29.4–33.4)40.2 (38.1–42.3)44.3 (41.5–47.0)46.2 (42.7–49.7)46.6 (41.8–51.4)52.5 (45.6–59.5)52.9 (42.3–63.6)62.5 (38.8–86.2)
        Controls††38.6 (37.9–39.2)40.5 (39.8–41.2)41.1 (40.3–41.9)42.5 (41.5–43.4)42.5 (41.3–43.8)44.2 (42.6–45.9)44.4 (41.8–47.0)43.2 (37.3–49.1)
    HgbA1c testing (among diabetics)‡‡
        Stage 0–1 CRC cases§§55.9 (53.0–58.7)60.1 (57.3–62.9)64.1 (60.9–67.2)64.3 (60.2–67.9)66.8 (62.2–71.3)70.1 (64.6–75.7)73.6 (66.7–80.4)67.9 (57.7–78.1)
        Stage 2–3 CRC cases‖∥53.4 (51.0–55.8)54.9 (52.5–57.3)59.4 (56.5–62.2)60.4 (56.9–63.8)64.4 (60.1–68.6)62.7 (57.2–68.1)62.5 (55.2–69.8)72.1 (61.4–82.7)
        Controls¶¶53.7 (52.6–54.7)58.7 (57.7–59.7)61.2 (60.0–62.2)62.9 (61.6–64.2)64.6 (63.1–66.1)66.1 (64.2–67.9)66.5 (64.2–68.9)67.8 (64.6–71.1)
    Serum lipid measurements (among diabetics)***
        Stage 0–1 CRC cases†††57.3 (54.4–60.2)52.8 (50.0–55.7)57.6 (54.3–60.8)53.6 (49.6–57.6)57.1 (52.4–61.9)60.5 (54.6–66.5)59.8 (52.1–67.4)59.3 (48.6–70.0)
        Stage 2–3 CRC cases‡‡‡51.0 (48.6–53.4)47.9 (45.5–50.3)48.6 (45.7–51.5)50.6 (47.1–54.1)52.1 (47.7–56.6)54.7 (49.0–60.3)51.8 (44.2–59.3)48.5 (46.7–60.4)
        Controls§§§52.6 (51.6–53.7)53.2 (52.1–54.2)54.4 (53.2–55.5)55.5 (54.2–56.8)57.9 (56.3–59.4)57.5 (55.6–59.4)58.5 (56.0–61.0)61.3 (57.9–64.7)
    • Values provided as % (CI).

    • * Difference in trend in receipt of influenza vaccination between stage 0–1 CRC cases and controls is nonsignificant, between stage 2–3 CRC cases and controls, P≤ .001; between stage 0–1 and stage 2–3, P ≤ .05.

    • † Test for trend in receipt of influenza vaccination over time for stage 0–1 CRC cases is nonsignificant.

    • ‡ Test for trend in receipt of influenza vaccination over time for stage 2–3 CRC cases, P ≤ .001.

    • § Test for trend in receipt of influenza vaccination over time for controls, P ≤ .01.

    • ‖ Difference in trend in receipt of mammography between stage 0–1 CRC cases and controls is nonsignificant; between stage 2–3 CRC cases and controls, P ≤ .001; between stage 0–1 and stage 2–3, P ≤ .05.

    • ¶ Test for trend in receipt of mammography over time for stage 0–1 CRC cases, P ≤ .001.

    • ** Test for trend in receipt of mammography over time for stage 2–3 CRC cases, P ≤ .001.

    • †† Test for trend in receipt of mammography over time for controls, P ≤ .001.

    • ‡‡ Difference in trend in HgbA1c testing between stage 0–1 CRC cases and controls is nonsignificant; between stage 2–3 CRC cases and controls is nonsignificant; and between stage 0–1 and stage 2–3 is nonsignificant.

    • §§ Test for trend in HgbA1c testing over time for stage 0–1 CRC cases, P ≤ .001.

    • ‖∥ Test for trend in HgbA1c testing over time for stage 2–3 CRC cases, P ≤ .001.

    • ¶¶ Test for trend in HgbA1c testing over time for controls, P ≤ .01.

    • *** Difference in trend in lipid testing between stage 0–1 CRC cases and controls is nonsignificant; between stage 2–3 CRC cases and controls, P ≤ .05; between stage 0–1 and stage 2–3 is nonsignificant.

    • ††† Test for trend in lipid testing over time for stage 0–1 CRC cases is nonsignificant.

    • ‡‡‡ Test for trend in lipid testing over time for stage 2–3 CRC cases is nonsignificant.

    • §§§ Test for trend in lipid testing over time for controls, P ≤ .001.

    • CRC, colorectal cancer; HgbA1c, hemoglobin A1c or glycosylated haemoglobin.

    • View popup
    Appendix:

    Medicare Claim Codes for Study Variables

    VariablesClaim TypeMedicare Claim Codes
    MammographyHCPCS/CPT76090, 76091, 76092
    Influenza vaccinationHCPCS/CPT90724, G0008, 90657–90660, Q0124
    ICD-9-CMV048, V066
    ICD-9-P99.52
    HgbA1cHCPCS/CPT83036
    Lipid testingHCPCS/CPT80061, 80062, 82465, 82470, 83700, 83705, 83715–83721, 84478
    Evidence of metastatic diseaseHCPCS/CPT36246, 36247, 47120, 47122, 47125, 47130, 47370, 47371, 47380, 47381, 47382, 76362, 76394, 76490, 36260, 47100, C2618
    ICD-9-CM197.0, 197.00, 197.04, 197.08, 197.1, 197.2, 197.3, 197.7, 197.70, 197.8, 198.3, 198.4, 198.41, 198.45, 198.48, 198.5, 198.51
    ICD-9-P50.2, 50.20, 50.21, 50.22, 50.29, 50.3, 50.30, 50.4, 50.40
    Recurrence treatment
        Chemotherapy:HCPCS/CPT96408, 96410, 96412, 96414, 96520, 96530, 96545, 96549, J9190, J0640, J9200, Q0083, Q0084, Q0085
    ICD-9-CMV58.1, E933.1, V66.2, V67.2
    ICD-9-P99.25
        Radiation therapy:HCPCS/CPT77261–63, 77280, 77285, 77290, 77295, 77299, 77300, 77305, 77310, 77315, 77321, 77326–8, 77331–4, 77336, 77370, 77399, 77401–17, 77419–32, 77470, 77490, 77499, 77750, 77761–3, 77776–8, 77781–4, 77789–90, 77797, 77799,
    ICD-9-CMV66.1, V67.1, V58.0
    ICD-9-P92.20–92.29
    Revenue center0333
    • HCPCS, Healthcare Common Procedure Coding System; CPT, Current Procedural Terminology; ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification; ICD-9-P, ICD-9-CM Procedure.

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The Journal of the American Board of Family Medicine: 24 (1)
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Receipt of General Medical Care by Colorectal Cancer Patients: A Longitudinal Study
Laura-Mae Baldwin, Sharon A. Dobie, Yong Cai, Barry G. Saver, Pamela K. Green, C. Y. Wang
The Journal of the American Board of Family Medicine Jan 2011, 24 (1) 57-68; DOI: 10.3122/jabfm.2011.01.100080

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Receipt of General Medical Care by Colorectal Cancer Patients: A Longitudinal Study
Laura-Mae Baldwin, Sharon A. Dobie, Yong Cai, Barry G. Saver, Pamela K. Green, C. Y. Wang
The Journal of the American Board of Family Medicine Jan 2011, 24 (1) 57-68; DOI: 10.3122/jabfm.2011.01.100080
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