Routine Preventive Care and Cancer Surveillance in Long-Term Survivors (LTS) of Colorectal Cancer: Results from NSABP Protocol LTS-01 Hiroko Kunitake MD 1, Ping Zheng MD MS 2, Greg Yothers PhD 2, Stephanie Land PhD 2 Louis Fehrenbacher MD 3, Jeffrey Giguere MD 4, D.Lawrence Wickerham MD 2 Patricia A. Ganz MD 1, Clifford Y. Ko MD MSHS 1 1 David Geffen School of Medicine at UCLA; 2 NSABP Operations and Biostatistics Center, University of Pittsburgh; 3 Kaiser Permanente Medical Center, Vallejo, CA 4 Cancer 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 Recruited LTS patients from five NSABP adjuvant therapy trials  Colon cancer: C-05, C-06, C-07  Rectal cancer: R-02, R-03 Aims of LTS-01: Characterize LTS  Quality of Life  Functional Outcomes  Clinical Symptoms  Health Behaviors  Routine Preventive Care  Cancer Screening  Cancer Surveillance

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

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

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 2,408 Patients contacted 976 Patients not interested 232 Did not complete interview 36 Completed interview 708 Patients interested 744

LTS-01 Recruitment Results Total eligible patients 2,408 Patients contacted 976 Patients not interested 232 Did not complete interview 36 Completed interview 708 Patients interested 744

LTS-01 Participants Colon cancer trials Patients  C  C  C Rectal cancer trials  R  R Total: 708 patients

LTS-01 Participation Rates

Demographics Variables LTS-01 N= 708 NHIS N= 2124 Gender Male57.1% Age (in years) < ≥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% Hispanic Yes No 3.8% 96.2% 10.2% 89.8%

Demographics Variables LTS-01 N= 708 NHIS N= 2124 p-value Education Less than high school High school graduate College Post graduate 6.2% 53.5% 21.8% 18.5% 21.1% 38.7% 22.0% 18.3% < Married75.9%54.6%< Health insurance99.0%93.3%< Private insurance76.1%66.5%<0.0001

LTS-01 and NHIS Comorbidities

Health Behaviors Health Behavior LTS-01 N= 708 NHIS N= 2124 p-value Have a usual source of care97.7%93.8%< ER visits in past 12 months None One Two or more 78.0% 14.4% 7.6% 80.6% 13.7% 5.7% Had flu shot in past 12 months67.5%44.3%<0.0001

Factors associated with Usual Source of Care PredictorsOdds Ratio 95% Wald Confidence Limits p-value Health insurance to 12.73< Diabetes to Private insurance to LTS to Age to Male to

Factors Associated with Flu Shot PredictorsOdds Ratio 95% Wald Confidence Limits p-value Health Insurance to 4.85< LTS to 3.53< Age to 2.57< Diabetes to 2.86< Heart disease to 2.28< Lung disease to Education to Male to Hispanic to

Cancer Screening Screening TestLTS-01NHIS p-value PAP smear in past 12 months* 67.3% 54.8% < Mammogram in past 12 months* 84.4%70.7% < PSA test in past 12 months# 84.5%74.5% < * Women only # Men only

LTS-01 Cancer Surveillance Surveillance TestPercent 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 PredictorsOdds Ratio 95% Wald Confidence Limits p-value LTS to Education to Heart Disease to Stroke to 2.65< Chronic Lung Disease to Diabetes to Kidney Disease to Bowel Disease to

Cancer Screening by Age: Pap smear

Cancer Screening by Age: Mammogram

Cancer Screening by Age: PSA test