Minorities in HMOs Less Likely to Receive Colon Cancer Surveillance

Oncology NEWS InternationalOncology NEWS International Vol 9 No 7
Volume 9
Issue 7

SAN DIEGO-Despite the egalitarian nature of health maintenance organizations (HMOs), minority and low-income patients enrolled in such plans may not receive the same colorectal cancer surveillance care as whites and higher income patients.

SAN DIEGO—Despite the egalitarian nature of health maintenance organizations (HMOs), minority and low-income patients enrolled in such plans may not receive the same colorectal cancer surveillance care as whites and higher income patients.

Tamir Ben-Menachem, MD, director of endoscopy, Henry Ford Hospital, Detroit, and Jennifer Elston-Lafata, PhD, director of the Center for Health Services Research, reported these findings at the American Gastro-enterological Association (AGA) annual meeting, held during the Digestive Disease Week conference.

Dr. Ben-Menachem and his colleagues decided to take a look at HMO population care after reading reports that colorectal cancer screening rates are lower in minority Medicare patients. “We sought to find out if patients in a full-service HMO environment received similar post-treatment surveillance care,” he said. “With full coverage, money shouldn’t be an issue.”

The researchers utilized a 500,000-member cancer registry and identified HMO patients diagnosed with stage I, II, or III colorectal cancer between 1990 and 1995. Claims data were used to gather information about the frequency and timing of tests used to detect local recurrence (colonoscopy, sigmoidoscopy, and air contrast barium enema) or metasta-ses (CEA, liver enzyme, chest x-ray, bone scan, and CT scan).

A total of 251 patients with an average age of 65 were studied from the time of treatment until recurrence, death, or disenrollment from the HMO, or until the end of 1997. Of these patients, 63% were white, 34% were black, and 62% were men. Dr. Ben-Menachem said that the rates of local recurrence, metastatic disease, and mortality were similar among the various demographic groups.

A complete examination of the colon was performed in 49% of all patients at the 1-year mark, and in 78% by 5 years. Younger patients, whites, and higher-income patients were more likely to receive a complete colon examination than were older patients, blacks, or patients with lower incomes.

The average cost of medical care per patient over the 8-year follow-up period was $35,441 for whites and $24,299 for blacks.

“There were two major differences we found between how patients received treatment—race and median income,” Dr. Ben-Menachem said. “We were a little surprised. Despite equal health care coverage and equal access to physicians, patients were not utilizing the same ser-vices. Perhaps we’re not doing a good job of explaining why they need follow-up care. Maybe there are cultural issues and they don’t trust us. It’s a tough question to answer.”

Drs. Ben-Menachem and Elston-Lafata further commented that “there is much we still do not know about why these differences exist for both HMO and Medicare patients. Research to help us understand this important question is currently underway at Henry Ford Hospital.”

Related Videos
Rates of obesity appear to correlate with increasing incidence of cancer in young populations, according to Monique Gary, DO, MSc, FACS.
Data from a ctDNA analysis of the phase 3 INTRIGUE study indicate that KIT mutational status may be associated with response to certain Tyrosine kinase inhibitors in GIST, according to an expert from the Yale Cancer Center in New Haven, Massachusetts.
Future research into the management of unresectable hepatocellular carcinoma may involve combining local therapies with checkpoint inhibitors like durvalumab and tremelimumab, according to Ghassan K. Abou-Alda, MD.
Patients with unresectable hepatocellular carcinoma who have recurrent disease following surgery or locally advanced diseases who will likely progress on local therapy may have an opportunity to benefit from tremelimumab and durvalumab following its FDA approval, according to Ghassan K. Abou-Alfa, MD.
Ghassan K. Abou-Alfa, MD, discusses the importance of improving access to novel therapies and combinations for patients with hepatocellular carcinoma across the world.
Ghassan K. Abou-Alfa, MD, spoke about the recent approval of tremelimumab plus durvalumab for patients with unresectable hepatocellular carcinoma, based on results from the phase 3 HIMALAYA trial.
Howard A. Burris, MD, highlighted previous findings of the phase 3 TOPAZ-1 trial assessing durvalumab plus gemcitabine and cisplatin vs placebo plus gemcitabine and cisplatin in advanced biliary tract cancer and patient-reported outcomes (PRO)data that were presented at 2022 ASCO.
Shubham Pant, MD discusses key findings from a basket trial examining the use of erdafitinib in patients with gastrointestinal cancers.
Related Content