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APHA Scientific Session and Event Listing

Recorded presentation

Katherine Virgo, PhD, MBA¹, Mary P. Valentine, BDS, MPH¹, Lucille Dauz, MPH¹, Lan H. Marietta, MPH¹, Brandie S. Adams, MPH¹, Sangita Devarajan, MBChB, MPH¹, Walter E. Longo, MD², and Frank E. Johnson, MD¹. (1) Dept. of Surgery, Saint Louis University & Saint Louis VAMC, 3635 Vista at Grand Boulevard, Saint Louis, MO 63110-0250, 314-289-7023, virgoks@slu.edu, (2) Yale University, 333 Cedar Street, New Haven, CT 06520

Background: Many individuals are concurrently eligible for multiple sources of government-reimbursed health care services (e.g. Department of Veterans Affairs (VA)- and Medicare-reimbursed care). Unclear is whether combined eligibility translates into increased access to care and/or improved outcomes of care. Alternatively, continuity of care may suffer leading to worse outcomes when patients receive health services from multiple unrelated sources of care. Methods: Retrospective analyses of 13 years of nationwide Medicare and VA inpatient and institutional outpatient data beginning with three years pre-diagnosis (1986-1990) through a minimum of five years post-diagnosis (1994-1998) was conducted. Death data were available through June 2005. Data were also extracted from tumor registry files, computerized patient files, and medical records at each VA. The population studied included all VA patients diagnosed with colorectal cancer and surgically treated for cure during the five-year period 1989-1993, who were Medicare-eligible at diagnosis, and survived the index admission. Kaplan Meier and Cox regression methods were used to analyze survival. Results: Of 6612 patients treated with curative intent, 4924 (74%) could be staged. Of these, 4551 (92%) were eligible for analysis. Of these, 77% and 23% were diagnosed with colon and rectal cancer, respectively. The distribution of TNM stage was 2.7% Stage 0, 25.9% Stage I, 33.2% Stage II, 24.7% Stage III, and 13.4% Stage IV. Histopathologic tumor grade was primarily either moderately differentiated (54%) or well differentiated (19%). By June 2005, 77% had died. Average survival in months after treatment of the initial primary was 86 (median=61). Survivorship differed significantly by stage at diagnosis (p<.001), histopathologic grade (p<.001), region (p<.001), marital status (p<.001), age (p<.001), gender (p<.05), and dual use (p<.05). Patients who were dual users were 13 percent more likely to survive than those who used VA-reimbursed services only or Medicare-reimbursed serviced only, controlling for stage, histopathologic grade, region, marital status, age, gender, and race. Dual users were also more likely (p<.01) to have recurrence detected and were borderline less likely (p =.046) to have a second primary detected. Conclusions: An important benefit of dual eligibility for government-reimbursed health care services is significantly increased likelihood of survival. The impact on survivorship of a higher recurrence detection rate among dual users and a borderline lower second primary detection rate is currently being examined. Another benefit of increased access to care permitted by dual eligibility may be a higher curative treatment rate per detected recurrence.

Learning Objectives:

• Assess the impact of concurrent eligibility for multiple sources of government-reimbursed health care services on survivorship for colorectal cancer patients.
• Identify other predictors of survivorship for this population.
• Explain why higher colorectal cancer recurrence rates are detected among the dually eligible.

Keywords: Access, Cancer

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation