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. 2020 Apr 14;15(4):e0231599.
doi: 10.1371/journal.pone.0231599. eCollection 2020.

Racial/ethnic disparities in colorectal cancer treatment utilization and phase-specific costs, 2000-2014

Angela C Tramontano  1 , Yufan Chen  1 , Tina R Watson  1 , Andrew Eckel  1 , Chin Hur  2 , Chung Yin Kong  1   3
Affiliations

Racial/ethnic disparities in colorectal cancer treatment utilization and phase-specific costs, 2000-2014

Angela C Tramontano et al. PLoS One. .

Abstract

Background: Our study analyzed disparities in utilization and phase-specific costs of care among older colorectal cancer patients in the United States. We also estimated the phase-specific costs by cancer type, stage at diagnosis, and treatment modality.

Methods: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients aged 66 or older diagnosed with colon or rectal cancer between 2000-2013, with follow-up to death or December 31, 2014. We divided the patient's experience into separate phases of care: staging or surgery, initial, continuing, and terminal. We calculated total, cancer-attributable, and patient-liability costs. We fit logistic regression models to determine predictors of treatment receipt and fit linear regression models to determine relative costs. All costs are reported in 2019 US dollars.

Results: Our cohort included 90,023 colon cancer patients and 25,581 rectal cancer patients. After controlling for patient and clinical characteristics, Non-Hispanic Blacks were less likely to receive treatment but were more likely to have higher cancer-attributable costs within different phases of care. Overall, in both the colon and rectal cancer cohorts, mean monthly cost estimates were highest in the terminal phase, next highest in the staging phase, decreased in the initial phase, and were lowest in the continuing phase.

Conclusions: Racial/ethnic disparities in treatment utilization and costs persist among colorectal cancer patients. Additionally, colorectal cancer costs are substantial and vary widely among stages and treatment modalities. This study provides information regarding cost and treatment disparities that can be used to guide clinical interventions and future resource allocation to reduce colorectal cancer burden.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Phases of care timeline for CRC patients.
Fig 2
Fig 2. Mean monthly total costs by stage and phase: Colon cancer.
Fig 3
Fig 3. Mean monthly total costs by stage and phase: Rectal cancer.
See this image and copyright information in PMC

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