Routine Preventive Care and Cancer Surveillance in Long-

Term Survivors (LTS) of Colorectal Cancer:

Results from NSABP Protocol LTS-01

Hiroko Kunitake MD1, Ping Zheng MD MS2, Greg Yothers PhD2, Stephanie Land PhD2

Louis Fehrenbacher MD3, Jeffrey Giguere MD4, D.Lawrence Wickerham MD2

Patricia A. Ganz MD1, Clifford Y. Ko MD MSHS1

1David Geffen School of Medicine at UCLA; 2NSABP Operations and Biostatistics Center, University of Pittsburgh; 3Kaiser Permanente

Medical Center, Vallejo, CA4Cancer Center of the Carolinas

Disclosures

• We have no disclosures

Long-Term Survivors

• Growing population of Long-Term Survivors (LTS) of Colorectal Cancer 10% of 11.1 million cancer survivors in

US

• Little known about LTS use of: Routine Preventive Care Cancer Screening Cancer Surveillance

How do you identify LTS?

• Difficulty in gathering consistent LTS study cohort

• Previous studies used Cancer Registries

• Possibility of gathering study cohort from Colorectal cancer clinical trials

NSABP LTS-01 Study

Aims

1. Characterize LTS-01 Routine Preventive Care Comparison with non-cancer general population

2. Determine LTS-01 rates of Cancer Screening Comparison with non-cancer general population

3. Evaluate LTS-01 Cancer Surveillance

Methods • LTS-01 Cohort

Recruited from 60 NSABP study sites Participated in C-05, C-06, C-07, R-02, R-

03 5+ year survival Received computer assisted telephone

interview (CATI)

NSABP Participating Sites

Methods

Methods • LTS-01 Cohort

Recruited from 60 NSABP study sites Participated in C-05, C-06, C-07, R-02, R-

03 5+ year survival Received computer assisted telephone

interview (CATI)

Years of Treatment Trial Accrual

C-07

Methods

Methods • LTS-01 Cohort

Recruited from 60 NSABP study sites Participated in C-05, C-06, C-07, R-02, R-03 5+ year survival Received computer assisted telephone

interview (CATI)• Control non-cancer cohort

National Health Interview Survey (NHIS) 2005 3:1 case-matched Matched on age, gender, race, education

Analysis

1. Routine Preventive Care of LTS-01 and NHIS Usual Source of Care, ER visits, Flu

shot

2. Cancer Screening of LTS-01 and NHIS Mammogram, Pap smear, PSA test

3. Cancer Surveillance of LTS-01 patients Colonoscopy, CEA test, CT scan

Methods

Analysis

• Comparison of LTS-01 and NHIS samples:Fisher’s Exact Test

• Predictors of Receipt of Care: Logistic Regression Models

Routine Preventive Care Cancer Screening Cancer Surveillance

Methods

LTS-01 Recruitment Results

Total eligible patients

2,408Patients

contacted976

Patients not interested

232Did not complete

interview36

Completed interview

708

Patients interested

744

LTS-01 Recruitment Results

Total eligible patients

2,408Patients

contacted976

Patients not interested

232Did not complete

interview36

Completed interview

708

Patients interested

744

LTS-01 Participants • Colon cancer trials Patients

C-05 147 C-06 180 C-07 354

• Rectal cancer trials R-02 15 R-03 12

Total: 708 patients

LTS-01 Participation Rates

DemographicsVariables LTS-01

N= 708NHIS

N= 2124Gender Male 57.1% 57.1%Age (in years) <50 50-59 60-69 ≥70

7.3%19.8%32.1%40.8%

7.3%19.8%32.1%40.8%

Race Black Other

2.7%97.3%

2.7%97.3%

HispanicYesNo

3.8%96.2%

10.2%89.8%

DemographicsVariables LTS-01

N= 708NHIS

N= 2124 p-value

Education Less than high schoolHigh school graduateCollegePost graduate

6.2%53.5%21.8%18.5%

21.1%38.7%22.0%18.3%

<0.0001

Married 75.9% 54.6% <0.0001

Health insurance 99.0% 93.3% <0.0001

Private insurance 76.1% 66.5% <0.0001

LTS-01 and NHIS Comorbidities

Health Behaviors

Health Behavior LTS-01N= 708

NHISN= 2124 p-value

Have a usual source of care 97.7% 93.8% <0.0001

ER visits in past 12 months None One Two or more

78.0%14.4%7.6%

80.6%13.7%5.7%

0.1619

Had flu shot in past 12 months 67.5% 44.3% <0.0001

Factors associated with Usual Source of Care

Predictors Odds Ratio

95% WaldConfidence

Limitsp-value

Health insurance 7.55 4.47 to 12.73 < 0.0001

Diabetes 6.70 2.42 to 18.53 0.0002

Private insurance 2.11 1.35 to 3.31 0.0010

LTS-01 1.79 1.04 to 3.09 0.0369

Age 1.33 1.10 to 1.62 0.0039

Male 0.67 0.46 to 0.97 0.0328

Factors Associated with Flu Shot

Predictors Odds Ratio

95% WaldConfidence

Limitsp-value

Health Insurance 2.99 1.84 to 4.85 <0.0001

LTS-01 2.88 2.35 to 3.53 <0.0001

Age 2.32 2.10 to 2.57 <0.0001

Diabetes 2.23 1.74 to 2.86 <0.0001 Heart disease 1.76 1.36 to 2.28 <0.0001

Lung disease 1.52 1.18 to 1.96 0.0011

Education 1.14 1.04 to 1.25 0.0040

Male 0.74 0.63 to 0.89 0.0009

Hispanic 0.67 0.49 to 0.92 0.0140

Cancer Screening

Screening Test LTS-01 NHIS p-value

PAP smear in past 12 months* 67.3% 54.8% <0.0001

Mammogram in past 12 months* 84.4% 70.7% <0.0001

PSA test in past 12 months# 84.5% 74.5% <0.0001

* Women only # Men only

LTS-01 Cancer Surveillance

Surveillance Test Percent

Colonoscopy In last 2 years In last 5 years

74.1%96.5%

Carcinoembryonic Antigen Test In last 2 years In last 5 years

71.8%88.0%

Computed Tomography Scan In last 2 years In last 5 years

43.9%66.4%

LTS-01 Cancer Surveillance and Survivorship

Summary

• LTS-01 patients More usual source of care Higher rates of flu shot More cancer screening High rates of cancer surveillance

• Highly motivated LTS-01 patients

Limitations• Selective participation of LTS-01 patients

• Variation in length of survival among cancer trials

• Nationally representative sample of CRC survivors

• Ability to link cancer treatment to late effects

Strengths

Implications

• Clinical trials as a source of long-term survivor information

• Further results of LTS-01 patient-reported outcomes to follow

Extra slides

Factors Associated with ER Use

Predictors Odds Ratio

95% WaldConfidence

Limitsp-value

LTS-01 1.18 0.95 to 1.47 0.1298

Education 0.87 0.79 to 0.95 0.0037

Heart Disease 1.40 1.09 to 1.80 0.0079

Stroke 1.92 1.39 to 2.65 <0.0001

Chronic Lung Disease 1.57 1.22 to 2.01 0.0005

Diabetes 1.28 1.00 to 1.64 0.0464

Kidney Disease 1.47 0.99 to 2.17 0.0573

Bowel Disease 1.61 1.21 to 2.15 0.0011

Cancer Screening by Age: Pap smear

Cancer Screening by Age: Mammogram

Cancer Screening by Age: PSA test