Abstract 1910: Patient race and ethnicity, experiences with care, and guideline concordant treatment for colorectal cancer among those with multimorbidity
Authors: Navarro Stephanie , Tsui Jennifer , Barzi Afsaneh , Stern Mariana , Pickering Trevor , Farias Albert 
Published: April 2023

Purpose: Among patients with colorectal cancer (CRC), racial and ethnic minorities and those with comorbid chronic conditions are less likely to receive guideline concordant treatment (GCT). Yet, positive patient experience with health care is associated with higher likelihood of receiving GCT for noninvasive CRC. This research examines the relationship between patient experiences with care, receipt of GCT for CRC, and patient race and ethnicity among those diagnosed with CRC and comorbid chronic conditions.

Methods: We used the Surveillance, Epidemiology, and End Results (SEER)-Consumer Assessment of Healthcare Providers and Systems (CAHPS) data to identify patients diagnosed with noninvasive CRC from 2001-2017 who were at least 67 years old at diagnosis; had diabetes, hyperlipidemia, and/or hypertension; and responded to a CAHPS patient experience survey within 3 years of CRC diagnosis. GCT was defined as stage-specific National Comprehensive Cancer Center recommended treatment for CRC and was identified in Medicare claims files. CAHPS patient experiences of care coordination (CC), getting care quickly (GCQ), getting needed care (GNC), and physician communication (PC) were categorized as excellent and less than excellent. Multivariable logistic regression analyses included a product interaction term between patient race and ethnicity and experiences with care to measure the associations between race and ethnicity and receipt of GCT and how these differ by self-reported experiences with care.

Results: 3,442 SEER-CAHPS patients with CRC and comorbid chronic conditions, including 44.4% with diabetes, 74.2% with hyperlipidemia, and 92.0% with hypertension were included. 71.5% of non-Hispanic Whites (NHW), 68.3% of non-Hispanic Blacks (NHB), 72.2% of Hispanics, and 72.9% of non-Hispanic Asians (NHA) received stage specific GCT for CRC. Among those reporting excellent experience with GNC, NHBs, Hispanics, and NHAs were more likely than NHWs to receive GCT (NHB: OR=1.33, 99.38% CI=1.27-1.38; Hispanic: 1.09, 1.04-1.15; NHA: 1.49, 1.41-1.57). Among those reporting excellent experiences of CC and PC, NHBs were more likely than NHWs to receive GCT (CC: 1.45, 1.31-1.61; PC: 1.52, 1.46-1.57). However, Hispanics and NHAs reporting excellent experiences with PC were less likely than NHWs to receive GCT (Hispanic: 0.76, 0.72-0.79; NHA: 0.91, 0.86-0.96).

Conclusions: Improvements in patient experiences with care may help to alleviate some racial and ethnic disparity in receipt of GCT for CRC among those with multimorbidity. However, improvements in experiences should be specific to individual aspects of care (CC, GNC, and PC) and may not fully address treatment disparities in Hispanic and NHA populations with CRC and comorbid chronic conditions.

Citation Format: Stephanie Navarro, Jennifer Tsui, Afsaneh Barzi, Mariana Stern, Trevor Pickering, Albert Farias. Patient race and ethnicity, experiences with care, and guideline concordant treatment for colorectal cancer among those with multimorbidity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1910.