ASPO Abstracts
Are low-income participants in a comprehensive cancer survivorship program more likely to receive colorectal and breast cancer screening?
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research, Early Detection & Risk Prediction
Conference Year: 2018
Abstract Body:
Background Comprehensive cancer survivorship programs provide lifestyle education and counseling that may result in improved adherence to recommended preventive services such as cancer screening. We studied survivors receiving care at an urban safety-net healthcare system serving low-income, uninsured patients in Tarrant County, TX. We compared breast and colorectal cancer (CRC) screening among program participants and non-participants. Methods We merged data from 3 sources: tumor registry and electronic medical records from the healthcare system and the program database. We identified patients diagnosed with any cancer type, 2008—15; we matched each participant with 3 non-participants using propensity scores including sex, age, race/ethnicity, language, marital status, alcohol and tobacco use, number of total primary cancers, cancer type, stage, grade, and diagnosis year and location. We measured mammography among females aged 40 years not diagnosed with breast cancer. We measured CRC screening among patients aged 50 years not diagnosed with CRC. We used mixed Poisson models to describe screening uptake (yes vs. no) each year after program enrollment (participants) or diagnosis (non- participants) until end of follow-up. We compared screening of participants vs. non-participants using matched data, including patient-level random effects and adjusting for follow-up time. Results Race/ethnicity was evenly split between Hispanic, White, or Black. Of 157 participants and 471 matched non-participants eligible for mammography, most had uterine (15.3%) or colorectal cancer (13.5%), and had localized or in situ disease (41.4%). Of 269 participants and 807 matched non- participants eligible for CRC screening, most were female (65.6%), had breast (27.6%) or prostate (10.8%) cancer, and had localized or in situ disease (44.4%). Program participants were more likely to complete CRC screening (RR=1.56, p=0.04), but not mammography (RR=1.49 p=0.21), when compared to matched non-participants. Conclusion Survivorship programs–even those not designed to focus on screening behavior–may increase CRC screening among participants. Future efforts should focus on increasing mammography and other recommended preventive services among survivors participating in these programs.
Keywords: cancer survivorship, cancer screening, program evaluation,