The Identification of Prognostic Factors of Late Stage Disease, Particularly Those That Are Modifiable, That Might Explain the Worsened Prognosis With Colorectal Cancer Among Veterans.
Condition: Colorectal Cancer
MeSH terms: Colorectal Neoplasms
Study type: Observational

Summary: 
      Colorectal cancer is the second leading cause of cancer death in the United States each year.
      Approximately one million veterans aged 50 and older will develop colorectal cancer over the
      remainder of their lives and nearly 433,000 will die from it. Because most cancers are
      diagnosed after local or regional spread, nearly half of all patients diagnosed with
      colorectal cancer will die. On a national basis, the relative five year survival with
      colorectal cancer was estimated at approximately 40% among veterans, substantially lower than
      SEER estimates in the general population of 61.7% (colon) and 59.3% (rectum). Colorectal
      cancer is preventable through screening, however and, if diagnosed in an early stage (Dukes'
      A and B), is curable.

      This is the first study to examine factors that might explain the worsened prognosis for
      veterans with colorectal cancer. If modifiable factors such as physician and patient delay in
      diagnosis, or poverty, explain the increased mortality among veterans, educational programs
      and interventions that improve the process of care associated with screening and diagnosis
      can be instituted.
    

Detailed description: 
      Primary Objectives: To identify prognostic factors of late stage disease, particularly those
      that are modifiable, that might explain the worsened prognosis with colorectal cancer among
      veterans and that also might be responsive to intervention. Interventions directed at these
      factors could lead to a decreased mortality among veterans.

      Secondary Objectives: To compare outcomes among veterans with similar non-veterans who are
      participating in the NCI-funded study: "Population Study of Colon Cancer in Blacks and
      Whites" that is in-progress at the University of North Carolina at Chapel Hill.

      Primary Outcomes: The primary outcomes are stage of disease and delay of diagnosis. Delay of
      diagnosis is determined by length of time between symptom onset and medical consultation
      (patient delay) and length of time between first seeking medical consultation and diagnosis
      (physician or system delay). Stage of disease will be used as a proxy for survival.

      Intervention: N/A

      Study Abstract: Colorectal cancer is the second leading cause of cancer death in the United
      States each year. Approximately one million veterans aged 50 and older will develop
      colorectal cancer over the remainder of their lives and nearly 433,000 will die from it.
      Because most cancers are diagnosed after local or regional spread, nearly half of all
      patients diagnosed with colorectal cancer will die. On a national basis, the relative five
      year survival with colorectal cancer was estimated at approximately 40% among veterans,
      substantially lower than SEER estimates in the general population of 61.7% (colon) and 59.3%
      (rectum). Colorectal cancer is preventable through screening, however and, if diagnosed in an
      early stage (Dukes' A and B), is curable.

      This is the first study to examine factors that might explain the worsened prognosis for
      veterans with colorectal cancer. If modifiable factors such as physician and patient delay in
      diagnosis, or poverty, explain the increased mortality among veterans, educational programs
      and interventions that improve the process of care associated with screening and diagnosis
      can be instituted.

      To-date, 659 subjects have been enrolled. Study participation involves obtaining demographic,
      pathology and patient contact data on all colorectal cancer patients at the 14 participating
      sites and conducting a one-time telephone interview. Preliminary study data suggests that
      most veterans with colorectal cancer present with evidence of regional or distant spread of
      their colorectal cancer. No significant difference in stage at presentation among veterans
      versus the population-based SEER patients is evident. Fewer veterans present with localized
      disease (33% versus 40%) and, although not statistically significant, could suggest a trend
      toward presentation at a more advanced stage.

      Results of this study will provide a profile of patients at high-risk of presenting with
      advanced colorectal cancer. This profile may be useful in designing patient and health care
      system focused interventions to improve stage at diagnosis.

      Final Results: Analyses are underway. A Final Report will be submitted to Durham ERIC within
      90 days of study end date (03/31/02).
    

Keywords: colorectal cancer