Abstract A129: Racial/ethnic disparities in patient experiences with health care and the association with earlier stage at colorectal cancer diagnosis: Findings from the SEER-CAHPS data
Authors: Ochoa Carol Y , Toledo Gabriela , Farias Albert J 
Published: September 2020

Background: Racial/ethnic minorities are more likely to be diagnosed at a later stage of colorectal cancer (CRC). Disparities in late-stage CRC diagnosis are partly attributed to socioeconomic inequalities, poor access to early detection screening and poor access to timely, high-quality diagnostic care. Although these findings are useful for identifying subgroups at high-risk for late-stage CRC diagnosis, few studies have focused on potentially modifiable factors at the patient, healthcare system and provider-level. Therefore, our objective was to identify whether racial/ethnic differences in patient experiences with healthcare are associated with stage at CRC diagnosis. Methods: We used the NCI Surveillance, Epidemiology and End Results (SEER) registry data linked with patient surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS). CAHPS surveys are administered to a random sample of Medicare beneficiaries on fee-for-service or Medicare advantage health plans by the Centers for Medicaid and Medicare Services. We conducted a retrospective cohort analysis of patients &gt;64 years old diagnosed with colorectal cancer from 1997-2011 who completed a CAHPS survey prior to the date of their CRC diagnosis. We examined the composite measures from CAHPS survey to assess patient experiences with care which we categorized into three domains: 1) patient-centeredness, 2) timeliness, and 3) realized access. Race/ethnicity was assessed using a self-reported measure from the CAHPS survey. We used multivariable linear regression to examine racial/ethnic differences in patient experiences with care for each domain controlling for sociodemographic and health characteristics. We ran a multivariable logistic regression model to determine the association between patient experiences with care and earlier stage (stage 0 and 1) at diagnosis. Results: Of the 9,211 patients, 79.7% were non-Hispanic white, 7.7% black, 7.4% Hispanic, and 5.2% Asian. After controlling for potential confounders, for the timeliness of care domain, Asian patients had significantly lower adjusted mean scores for getting care quickly (B=-6.65, 95% CI: -9.44, -3.87) compared to white patients. While for the realized access domain, Asian and non-Hispanic black patients had significantly lower adjusted mean scores for getting needed prescription drugs, B=-5.78 (95% CI: -8.51, -3.05) and B=-3.18 (95% CI: -5.50, -0.87), respectively. More importantly, we found that black patients who reported a 5-unit increase in rating of their experiences with getting needed care quickly (OR: 1.06, 95% CI: 1.01-1.10) had higher odds of being diagnosed at an earlier stage of colorectal cancer. Conclusion: There are racial/ethnic disparities in patient experiences with timeliness of and realized access to care preceding a diagnosis of colorectal cancer. Our study suggests that among black patients, poor experiences with timeliness of care may be associated with later stage at diagnosis.

Citation Format: Carol Y Ochoa, Gabriela Toledo, Albert J Farias. Racial/ethnic disparities in patient experiences with health care and the association with earlier stage at colorectal cancer diagnosis: Findings from the SEER-CAHPS data [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A129.