INTRODUCTION:To improve colorectal cancer outcomes,appropriate adjuvant therapy(chemotherapy,radiation therapy)should be given.Numerous studies have demonstrated underuse of adjuvant therapy in colorectal cancer.The current study examines variables associated with underuse of adjuvant therapy.METHODS:Three population-based databases were linked:California Cancer Registry,California Patient Discharge Database,2000 Census.All colorectal cancer patients diagnosed from 1994 to 2001 were studied.Patient characteristics(age,gender,race/ethnicity,comorbidities,payer,diagnosis year,socioeconomic status)were used in five multivariate regression analyses to predict receipt of chemotherapy for Stage Ⅲcolon cancer,and receipt of chemotherapy and radiation therapy for Stages Ⅱ,Ⅲrectal cancer.RESULTS:The overall cohort was 18,649 Stage Ⅲcolon cancer and Stages Ⅱ,Ⅲrectal cancer patients.Mean age was 68.9 years,50 percent male,74 percent non-Hispanic white,6 percent black,11 percent Hispanic,9 percent Asian,and 65 percent had no significant comorbid disease.Receipt of chemotherapy was 48 percent for Stage Ⅲcolon cancer,48 percent for Stage Ⅱrectal cancer,and 66 percent for Stage Ⅲrectal cancer.Receipt of radiation therapy was 52 percent for Stage Ⅱrectal cancer and 66 percent for Stage Ⅲrectal cancer.In all five models,low socioeconomic status predicted underuse of chemotherapy or radiation therapy(P < 0.016).Race/ethnicity was not statistically associated with underuse in any of the models.CONCLUSIONS:Most literature identifies race/ethnicity as the reason for disparate receipt of adjuvant therapy in colorectal cancer.Using a more robust database of three population-based sources,our analysis demonstrates that socioeconomic status is a more important predictor of(in)appropriate care than race/ethnicity.Explicit measures to improve care to the poor with colorectal cancer are needed.
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