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Factors Influencing Adherence to Recommended Colorectal Cancer Surveillance: Experiences and Behaviors of Colorectal Cancer Survivors

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Abstract

The number of colorectal cancer (CRC) survivors in the USA is increasing and factors associated with CRC surveillance require attention. This study examined the role of personal, provider, and practice-level factors on CRC survivor care surveillance experiences and outcomes. A telephone survey, informed by the Chronic Care Model, was conducted over a 1-year period with 150 CRC survivors identified via the South Carolina Central Cancer Registry. Participants were ages ≥ 21 years and diagnosed with stages I–III CRC within 1.5 years of study enrollment. Data were analyzed using descriptive statistics and logistic regression. Adherence was defined as receipt of surveillance colonoscopy at 13 months post-CRC surgery, as recommended by evidence-based guidelines. The majority of participants were male (55%) and white (86%), with a median age of 65 years (range 25–89). Almost half (43%) had attained a high school degree or less. Cancer stage was fairly evenly distributed, and 58% had received treatment by surgery alone (provider-level factor). Few participants (56%) received a survivorship care plan (practice-level factor), and adherence to surveillance colonoscopy was lowest (36%) among participants with more than one comorbidity (personal-level factor). Logistic regression models showed that the only significant effect of personal, provider, or practice-level factors on CRC surveillance adherence was related to type of health insurance coverage (private/HMO vs. other; p = 0.04). This is one of the first studies to evaluate CRC surveillance in a socioeconomically diverse sample. The only associations found among the examined factors and adherence were related to type of health insurance coverage. Participants with private/HMO health insurance were significantly more likely than participants with “other” health insurance coverage types (i.e., none, Medicare without supplement, Medicare with supplement) to be adherent to the 13-month colonoscopy. Therefore, future education strategies and patient navigation interventions could focus on identifying and overcoming multi-level barriers to CRC surveillance services.

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Acknowledgements

The authors acknowledge the support of Dr. James Bearden and Ms. Lucy Gansauer of the Spartanburg Regional Healthcare System Gibbs Cancer Center.

Funding

This project was supported by the National Institutes of Health/National Cancer Institute (NIH/NCI) Grant Number 1R21CA152865-01, NIH/NCI Grant Number P20CA157071, and the South Carolina Clinical & Translational Research (SCTR) Institute, with an academic home at the Medical University of South Carolina, through NIH Grant Numbers UL1 RR029882 and UL1 TR000062. The work conducted in this study was supported in part by the Biostatistics Shared Resource, Hollings Cancer Center, Medical University of South Carolina, NIH/NCI Grant Number P30 CA138313.

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Authors and Affiliations

  1. Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA

    Marvella E. Ford, Katherine R. Sterba, Kent Armeson, Angela M. Malek, Kendrea D. Knight & Jane Zapka

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  1. Marvella E. Ford
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  2. Katherine R. Sterba
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  3. Kent Armeson
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  4. Angela M. Malek
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  5. Kendrea D. Knight
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  6. Jane Zapka
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Correspondence to Marvella E. Ford.

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Institutional Review Board Approval

Institutional Review Board (IRB) approval to conduct the study was obtained by the Medical University of South Carolina (MUSC) IRB as well as by the South Carolina Department of Health and Environmental Control (DHEC) IRB. Following the receipt of IRB approval, study participants were recruited by employing the following protocol.

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Ford, M.E., Sterba, K.R., Armeson, K. et al. Factors Influencing Adherence to Recommended Colorectal Cancer Surveillance: Experiences and Behaviors of Colorectal Cancer Survivors. J Canc Educ 34, 938–949 (2019). https://doi.org/10.1007/s13187-018-1398-5

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  • DOI: https://doi.org/10.1007/s13187-018-1398-5

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