The modifying effect of patient location on stage-specific survival following colorectal cancer using geosurvival models

Lung Chang Chien, Mario Schootman, Sandi L. Pruitt

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Colorectal cancer (CRC) is the third leading cause of cancer death in the US, and stage at diagnosis is the primary prognostic factor. To date, the interplay between geographic place and individual characteristics such as cancer stage with CRC survival is unexplored. We used a Bayesian geosurvival statistical model to evaluate whether the spatial patterns of CRC survival at the census tract level varies by stage at diagnosis (in situ/local, regional, distant), controlling for patient characteristics, surveillance test use, and treatment using linked 1991-2005 SEER-Medicare data of patients ≥ 66 years old in two US metropolitan areas. The spatial pattern of survival varied by stage at diagnosis for both cancer sites and registries. Significant spatial effects were identified in all census tracts for colon cancer and the majority of census tracts for rectal cancer. Geographic disparities appeared to be highest for distant-stage rectal cancer. Compared to those with in situ/local stage in the same census tracts, patients with distant-stage cancer were at most 7.73 times and 4.69 times more likely to die of colon and rectal cancer, respectively. Moreover, frailty areas for CRC at in situ/local stage more likely have a higher relative risk at regional stage, but not at distant stage. We identified geographic areas with excessive risk of CRC death and demonstrated that spatial patterns varied by both cancer type and cancer stage. More research is needed to understand the moderating pathways between geographic and individual-level factors on CRC survival.

Original languageEnglish (US)
Pages (from-to)473-484
Number of pages12
JournalCancer Causes and Control
Volume24
Issue number3
DOIs
StatePublished - Mar 2013

Fingerprint

Colorectal Neoplasms
Censuses
Survival
Rectal Neoplasms
Neoplasms
Colonic Neoplasms
Statistical Models
Medicare
Registries
Cause of Death
Research
Therapeutics

Keywords

  • Colorectal cancer
  • Diagnosis stage
  • Geographic disparity
  • Geosurvival model

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

The modifying effect of patient location on stage-specific survival following colorectal cancer using geosurvival models. / Chien, Lung Chang; Schootman, Mario; Pruitt, Sandi L.

In: Cancer Causes and Control, Vol. 24, No. 3, 03.2013, p. 473-484.

Research output: Contribution to journalArticle

@article{1d2fde5f54c54776bb9123a51a1d13e4,
title = "The modifying effect of patient location on stage-specific survival following colorectal cancer using geosurvival models",
abstract = "Colorectal cancer (CRC) is the third leading cause of cancer death in the US, and stage at diagnosis is the primary prognostic factor. To date, the interplay between geographic place and individual characteristics such as cancer stage with CRC survival is unexplored. We used a Bayesian geosurvival statistical model to evaluate whether the spatial patterns of CRC survival at the census tract level varies by stage at diagnosis (in situ/local, regional, distant), controlling for patient characteristics, surveillance test use, and treatment using linked 1991-2005 SEER-Medicare data of patients ≥ 66 years old in two US metropolitan areas. The spatial pattern of survival varied by stage at diagnosis for both cancer sites and registries. Significant spatial effects were identified in all census tracts for colon cancer and the majority of census tracts for rectal cancer. Geographic disparities appeared to be highest for distant-stage rectal cancer. Compared to those with in situ/local stage in the same census tracts, patients with distant-stage cancer were at most 7.73 times and 4.69 times more likely to die of colon and rectal cancer, respectively. Moreover, frailty areas for CRC at in situ/local stage more likely have a higher relative risk at regional stage, but not at distant stage. We identified geographic areas with excessive risk of CRC death and demonstrated that spatial patterns varied by both cancer type and cancer stage. More research is needed to understand the moderating pathways between geographic and individual-level factors on CRC survival.",
keywords = "Colorectal cancer, Diagnosis stage, Geographic disparity, Geosurvival model",
author = "Chien, {Lung Chang} and Mario Schootman and Pruitt, {Sandi L.}",
year = "2013",
month = "3",
doi = "10.1007/s10552-012-0134-4",
language = "English (US)",
volume = "24",
pages = "473--484",
journal = "Cancer Causes and Control",
issn = "0957-5243",
publisher = "Springer Netherlands",
number = "3",

}

TY - JOUR

T1 - The modifying effect of patient location on stage-specific survival following colorectal cancer using geosurvival models

AU - Chien, Lung Chang

AU - Schootman, Mario

AU - Pruitt, Sandi L.

PY - 2013/3

Y1 - 2013/3

N2 - Colorectal cancer (CRC) is the third leading cause of cancer death in the US, and stage at diagnosis is the primary prognostic factor. To date, the interplay between geographic place and individual characteristics such as cancer stage with CRC survival is unexplored. We used a Bayesian geosurvival statistical model to evaluate whether the spatial patterns of CRC survival at the census tract level varies by stage at diagnosis (in situ/local, regional, distant), controlling for patient characteristics, surveillance test use, and treatment using linked 1991-2005 SEER-Medicare data of patients ≥ 66 years old in two US metropolitan areas. The spatial pattern of survival varied by stage at diagnosis for both cancer sites and registries. Significant spatial effects were identified in all census tracts for colon cancer and the majority of census tracts for rectal cancer. Geographic disparities appeared to be highest for distant-stage rectal cancer. Compared to those with in situ/local stage in the same census tracts, patients with distant-stage cancer were at most 7.73 times and 4.69 times more likely to die of colon and rectal cancer, respectively. Moreover, frailty areas for CRC at in situ/local stage more likely have a higher relative risk at regional stage, but not at distant stage. We identified geographic areas with excessive risk of CRC death and demonstrated that spatial patterns varied by both cancer type and cancer stage. More research is needed to understand the moderating pathways between geographic and individual-level factors on CRC survival.

AB - Colorectal cancer (CRC) is the third leading cause of cancer death in the US, and stage at diagnosis is the primary prognostic factor. To date, the interplay between geographic place and individual characteristics such as cancer stage with CRC survival is unexplored. We used a Bayesian geosurvival statistical model to evaluate whether the spatial patterns of CRC survival at the census tract level varies by stage at diagnosis (in situ/local, regional, distant), controlling for patient characteristics, surveillance test use, and treatment using linked 1991-2005 SEER-Medicare data of patients ≥ 66 years old in two US metropolitan areas. The spatial pattern of survival varied by stage at diagnosis for both cancer sites and registries. Significant spatial effects were identified in all census tracts for colon cancer and the majority of census tracts for rectal cancer. Geographic disparities appeared to be highest for distant-stage rectal cancer. Compared to those with in situ/local stage in the same census tracts, patients with distant-stage cancer were at most 7.73 times and 4.69 times more likely to die of colon and rectal cancer, respectively. Moreover, frailty areas for CRC at in situ/local stage more likely have a higher relative risk at regional stage, but not at distant stage. We identified geographic areas with excessive risk of CRC death and demonstrated that spatial patterns varied by both cancer type and cancer stage. More research is needed to understand the moderating pathways between geographic and individual-level factors on CRC survival.

KW - Colorectal cancer

KW - Diagnosis stage

KW - Geographic disparity

KW - Geosurvival model

UR - http://www.scopus.com/inward/record.url?scp=84878878708&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84878878708&partnerID=8YFLogxK

U2 - 10.1007/s10552-012-0134-4

DO - 10.1007/s10552-012-0134-4

M3 - Article

C2 - 23306551

AN - SCOPUS:84878878708

VL - 24

SP - 473

EP - 484

JO - Cancer Causes and Control

JF - Cancer Causes and Control

SN - 0957-5243

IS - 3

ER -