Colorectal cancer (CRC) is the fourth most common cancer in the United States and the secondleading cause of cancer deaths. Despite declines in CRC incidence rates, survival following diagnosis hasimproved only modestly over the past few decades. Even though environmental contexts play an importantrole in health, disease, and behavior, most studies about CRC survival have largely ignored the geographicvariation and importance of area-level socioeconomic conditions that have been associated with CRCscreening, CRC stage at diagnosis, and with the survival of many other cancers. CRC patients who live inareas with worse socioeconomic conditions have decreased survival than those who live under more affluentconditions; however, the mechanisms by which these area-level factors exert their influence on CRC survivalremain unclear. This amended application of the proposed population-based, prospective study has three specific aims.
Aim 1) Determine the extent of the geographic variation of CRC survival across the United States based onsmall geographic areas at the sub-county (census-tract) level using the linked Surveillance, Epidemiology, andEnd Results (SEER)-Medicare data for over 100,000 men and women aged 66 or older diagnosed with CRC.
Aim 2) Determine the extent to which lower CRC survival can be explained by higher area socioeconomicdeprivation among persons age 66 and older.
Aim 3) Identify potential mediating pathways by which higherarea socioeconomic deprivation is associated with lower CRC survival among persons age 66 and older,namely a) patient characteristics, b) physician and hospital characteristics, c) tumor characteristics, d) type oftreatment received, and e) surveillance for CRC after diagnosis to detect recurrence and metastases. A multilevel spatial model will be developed to address the specific aims of the proposed study. We willuse the following existing data sources: 1) 1992-2005 data from NCI's SEER program (survival, patientcharacteristics, type of treatment, tumor characteristics); 2) 1991-2005 Medicare data (patient characteristics,type of treatment, surveillance after diagnosis) which is linked to the SEER data; 3) 1991-2005 data from theProvider of Services File (hospital and physician characteristics), 4) 1990-2005 census data (area deprivationmeasures), and 5) Medicare Current Beneficiary Survey data. Advanced Bayesian spatial analyses of CRCsurvival will be performed and a geographic information system will be used to display the results. Our studywill increase understanding of and identify important mechanisms of the role of area-level socioeconomicdeprivation on CRC survival. In addition, this study will help provide opportunities for targeting specificgeographic areas to allocate resources and interventions locally to improve CRC survival using evidence-based approaches, thereby reducing health disparities associated with living in socioeconomically deprivedareas.

Public Health Relevance

Colorectal cancer is the second leading cause of cancer deaths. To reduce geographic disparities in survivalfollowing colorectal cancer and to develop and implement interventions that can be targeted locally; it isimperative to identify reasons for lower-than-expected survival.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
7R01CA137750-06
Application #
8752293
Study Section
Community Influences on Health Behavior (CIHB)
Program Officer
Elena, Joanne W
Project Start
2013-10-01
Project End
2015-02-28
Budget Start
2013-10-01
Budget End
2014-02-28
Support Year
6
Fiscal Year
2013
Total Cost
$123,110
Indirect Cost
$37,610
Name
Saint Louis University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
050220722
City
Saint Louis
State
MO
Country
United States
Zip Code
63103
Schootman, Mario; Gomez, Scarlett Lin; Henry, Kevin A et al. (2017) Geospatial Approaches to Cancer Control and Population Sciences. Cancer Epidemiol Biomarkers Prev 26:472-475
Ratnapradipa, Kendra L; Lian, Min; Jeffe, Donna B et al. (2017) Patient, Hospital, and Geographic Disparities in Laparoscopic Surgery Use Among Surveillance, Epidemiology, and End Results-Medicare Patients With Colon Cancer. Dis Colon Rectum 60:905-913
Schootman, M; Chien, L; Yun, S et al. (2016) Explaining large mortality differences between adjacent counties: a cross-sectional study. BMC Public Health 16:681
Schootman, Mario; Hendren, Samantha; Ratnapradipa, Kendra et al. (2016) Adoption of Robotic Technology for Treating Colorectal Cancer. Dis Colon Rectum 59:1011-1018
Deshpande, Anjali D; Schootman, Mario; Mayer, Allese (2015) Development of a claims-based algorithm to identify colorectal cancer recurrence. Ann Epidemiol 25:297-300
de Vries, Simone; Jeffe, Donna B; Pruitt, Sandi L et al. (2014) Patient, hospital, and geographic disparities associated with comanagement during hospitalization for colorectal cancer surgery. J Hosp Med 9:226-31
Schootman, Mario; Lian, Min; Pruitt, Sandi L et al. (2014) Hospital and geographic variability in thirty-day all-cause mortality following colorectal cancer surgery. Health Serv Res 49:1145-64
Pruitt, Sandi L; Davidson, Nicholas O; Gupta, Samir et al. (2014) Missed opportunities: racial and neighborhood socioeconomic disparities in emergency colorectal cancer diagnosis and surgery. BMC Cancer 14:927
de Vries, S; Jeffe, D B; Davidson, N O et al. (2014) Postoperative 30-day mortality in patients undergoing surgery for colorectal cancer: development of a prognostic model using administrative claims data. Cancer Causes Control 25:1503-12
Pruitt, Sandi L; Leonard, Tammy; Zhang, Song et al. (2014) Physicians, clinics, and neighborhoods: multiple levels of influence on colorectal cancer screening. Cancer Epidemiol Biomarkers Prev 23:1346-55

Showing the most recent 10 out of 22 publications