ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2014
Clinical, sociodemographic, and service provider determinants of guideline concordant colorectal cancer care for Appalachian residents.
Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 33 citations in OpenAlex.
- Differential extracellular matrix proteomic signatures in colorectal tumors from Appalachian and non-Appalachian patients.Oncology letters · 2025Article
- Unique Considerations in Caring for Rural Patients with Rectal Cancer: A Scoping Review of the Literature from the USA and Canada.Journal of clinical medicine · 2025Review
- Disparities in time to treatment initiation of invasive lung cancer among Black and White patients in Tennessee.PloS one · 2025Article
- Tracing the potential of networks to improve community cancer care: an in-depth single case study.Implementation science communications · 2021Article
- The Impact of Dementia on Cancer Treatment Decision-Making, Cancer Treatment, and Mortality: A Mixed Studies Review.JNCI cancer spectrum · 2021Review
- The association of comorbidities with administration of adjuvant chemotherapy in stage III colon cancer patients: a systematic review and meta-analysis.Therapeutic advances in medical oncology · 2021Article
- Factors associated with the survival of colorectal cancer in Mexico.Intestinal research · 2020Article
- Nonadherence to Standard of Care for Locally Advanced Colon Cancer as a Contributory Factor for High Mortality Rates in Kentucky.Journal of the American College of Surgeons · 2020Article
- Article
- Rectal cancer survival in the United States by race and stage, 2001 to 2009: Findings from the CONCORD-2 study.Cancer · 2017Article
- Colon cancer survival in the United States by race and stage (2001-2009): Findings from the CONCORD-2 study.Cancer · 2017Article
- Effects of Hospital Type and Distance on Lymph Node Assessment for Colon Cancer Among Metropolitan and Nonmetropolitan Patients in Appalachia.Medical care research and review : MCRR · 2016Article
- An integrated microfluidic system for screening of phage-displayed peptides specific to colon cancer cells and colon cancer stem cells.Biomicrofluidics · 2015Article
- Diabetes management before and after cancer diagnosis: missed opportunity.Annals of translational medicine · 2015Article
- The real difficulty in improving concordance of clinical practice with guidelines.Annals of translational medicine · 2015Article
- Individual, Area, and Provider Characteristics Associated With Care Received for Stages I to III Breast Cancer in a Multistate Region of Appalachia.Journal of oncology practice · 2015Article
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Authors and funding
10 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundColorectal cancer represents a significant cause of morbidity and mortality, particularly in Appalachia where high mortality from colorectal cancer is more prevalent. Adherence to treatment guidelines leads to improved survival. This paper examines determinants of guideline concordance for colorectal cancer.
methodsColorectal cancer patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Carolina) were linked to Medicare claims (2005-2009). Final sample size after exclusions was 2,932 stage I-III colon, and 184 stage III rectal cancer patients. The 3 measures of guideline concordance include adjuvant chemotherapy (stage III colon cancer, <80 years), ≥12 lymph nodes assessed (resected stage I-III colon cancer), and radiation therapy (stage III rectal cancer, <80 years). Bivariate and multivariate analyses with clinical, sociodemographic, and service provider covariates were estimated for each of the measures.
resultsRates of chemotherapy, lymph node assessment, and radiation were 62.9%, 66.3%, and 56.0%, respectively. Older patients had lower rates of chemotherapy and radiation. Five comorbidities were significantly associated with lower concordance in the bivariate analyses: myocardial infarction, congestive heart failure, respiratory diseases, dementia with chemotherapy, and diabetes with adequate lymph node assessment. Patients treated by hospitals with no Commission on Cancer (COC) designation or lower surgical volumes had lower odds of adequate lymph node assessment.
conclusionsClinical, sociodemographic, and service provider characteristics are significant determinants of the variation in guideline concordance rates of 3 colorectal cancer measures.
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