Abstract A058: Patient and neighborhood factors associated with receipt of surveillance colonoscopy among Medicare beneficiaries with surgically resected colorectal cancer
Authors: Sanchez Janeth I , Shankaran Veena , Unger Joseph , Thompson Beti 
Published: September 2020

Abstract
Background: After colorectal cancer (CRC) surgery, surveillance with colonoscopy is an important step for the early detection of local recurrence. Unfortunately, surveillance colonoscopy is underutilized and only about 55% of CRC patients receive a colonoscopy as recommended. Lower rates are observed among racial/ethnic minorities. Identifying the factors that contribute to disparities in receipt of surveillance colonoscopy can assist researchers in developing targeted interventions to promote surveillance colonoscopy for the early detection of recurrence. Purpose: This study assesses the association between patient- and neighborhood-level factors and receipt of surveillance colonoscopy. Methods: This retrospective population-based cohort study uses the National Cancer Institutes’ Surveillance, Epidemiology and End Results (SEER) – Medicare linked data collected from 2009 to 2014. We identified beneficiaries with surgically resected CRC stages II and III between the ages of 66 and 85. We used multivariate logistic regression to assess the effect of factors on receipt of colonoscopy. Results: A total of 6,602 patients were identified. Overall, 57.5% of patients received a colonoscopy within 18-months after surgery. After adjusting for patient- and neighborhood-level factors, Blacks had 29.6% lower odds of receiving a colonoscopy compared to non-Hispanic Whites (NHWs) (p=.002). Hispanics had 12.9% lower odds of receiving a colonoscopy compared to NHWs, however, this association was not significant (p&gt;.05). Among NHWs, older age, male gender, and single status were significantly associated with lower odds of receipt of colonoscopy. Clinical factors, such as higher stage, no comorbidities and receipt of chemotherapy, were significantly associated with higher odds of receipt of colonoscopy, but only among NHWs. The odds of receipt of surveillance colonoscopy was 35% lower among NHWs patients with Medicaid coverage compared to NHWs without coverage. Although not significant, Black and Hispanic patients with Medicaid coverage were more likely to receive a colonoscopy compared to their racial/ethnic counterparts without coverage. Hispanics residing in neighborhoods with median household incomes of $90K+ had significantly lower odds of receipt of colonoscopy compared to Hispanics residing in neighborhoods with incomes of $0-$30K. Conclusion: Receipt of initial surveillance colonoscopy remains low and disparities exist between Blacks and NHW patients. The association between factors that assess a patient’s ability to access colonoscopy and actual receipt of colonoscopy suggest inequitable access to surveillance colonoscopy within and across racial/ethnic groups.
Citation Format: Janeth I Sanchez, Veena Shankaran, Joseph Unger, Beti Thompson. Patient and neighborhood factors associated with receipt of surveillance colonoscopy among Medicare beneficiaries with surgically resected colorectal cancer [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 A058.