Skip to main content

Advertisement

SpringerLink
Log in

Follow-up surveillance among colorectal cancer survivors of different sexual orientations

  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to examine receipt of follow-up surveillance among sexual minority and heterosexual survivors and identify survivor-, physician-, and practice-level characteristics associated with follow-up surveillance.

Methods

An average of 3 years after their stage I–III colorectal cancer diagnosis, we recruited survivors from four cancer registries. A questionnaire, which queried about sexual orientation and other eligibility criteria, was mailed to all cancer survivors. Subsequently, 418 eligible survivors without recurrent disease participated in a telephone survey. Colorectal cancer–specific follow-up surveillance was defined as colonoscopy, carcinoembryonic antigen (CEA) test, or imaging test. We used logistic regression with forward selection to obtain models that best explained each follow-up test.

Results

About 10% of survivors received no follow-up surveillance, while 70% had colonoscopies. While survivors irrespective of sexual orientation received follow-up surveillance, sexual minority survivors had 3 times the odds of receiving imaging tests compared to heterosexual survivors. Having a designated provider of any specialty was most salient for the receipt of surveillance.

Conclusions

Sexual minority survivors’ greater receipt of imaging tests may indicate providers perceive them at greater risk for recurrence than heterosexual survivors. Future studies need to examine provider behaviors towards monitoring colorectal cancer survivors of diverse sexual orientations.

Implications for Cancer Survivors

Guidelines recommend surveillance of colorectal cancer survivors to improve survival. This study showed that having a designated provider for follow-up is most salient for the receipt of surveillance, most survivors receive surveillance, and sexual minority survivors had more imaging tests compared to heterosexual survivors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Goding Sauer A, Fedewa SA, Butterly LF, Anderson JC, et al. Colorectal cancer statistics, 2020. CA Cancer J Clin. 2020;70(3):145–64. https://doi.org/10.3322/caac.21601.

    Article  Google Scholar 

  2. Meyerhardt JA, Mangu PB, Flynn PJ, Korde L, Loprinzi CL, Minsky BD, et al. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol. 2013;31(35):4465–70. https://doi.org/10.1200/jco.2013.50.7442.

    Article  PubMed  Google Scholar 

  3. El-Shami K, Oeffinger KC, Erb NL, Willis A, Bretsch JK, Pratt-Chapman ML, et al. American Cancer Society Colorectal Cancer Survivorship Care Guidelines. CA Cancer J Clin. 2015;65(6):428–55. https://doi.org/10.3322/caac.21286.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Steele SR, Chang GJ, Hendren S, Weiser M, Irani J, Buie WD, et al. Practice guideline for the surveillance of patients after curative treatment of colon and rectal cancer. Dis Colon Rectum. 2015;58(8):713–25. https://doi.org/10.1097/dcr.0000000000000410.

    Article  PubMed  Google Scholar 

  5. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Colon Cancer. Version 4.2018. 2018.

  6. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Rectal Cancer. Version 3.2018. 2018.

  7. Zhao Y, Yi C, Zhang Y, Fang F, Faramand A. Intensive follow-up strategies after radical surgery for nonmetastatic colorectal cancer: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2019;14(7):e0220533. https://doi.org/10.1371/journal.pone.0220533.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Sehdev A, Sherer EA, Hui SL, Wu J, Haggstrom DA. Patterns of computed tomography surveillance in survivors of colorectal cancer at Veterans Health Administration facilities. Cancer. 2017;123(12):2338–51. https://doi.org/10.1002/cncr.30569.

    Article  PubMed  Google Scholar 

  9. Paulson EC, Veenstra CM, Vachani A, Ciunci CA, Epstein AJ. Trends in surveillance for resected colorectal cancer, 2001-2009. Cancer. 2015;121(19):3525–33. https://doi.org/10.1002/cncr.29469.

    Article  PubMed  Google Scholar 

  10. McDougall JA, Banegas MP, Wiggins CL, Chiu VK, Rajput A, Kinney AY. Rural disparities in treatment-related financial hardship and adherence to surveillance colonoscopy in diverse colorectal cancer survivors. Cancer Epidemiol Biomark Prev. 2018;27(11):1275–82. https://doi.org/10.1158/1055-9965.Epi-17-1083.

    Article  Google Scholar 

  11. Hines RB, Jiban MJH, Lee E, Odahowski CL, Wallace AS, Adams SJE, et al. Characteristics associated with nonreceipt of surveillance testing and the relationship with survival in stage II and III colon cancer. Am J Epidemiol. 2020;190:239–50. https://doi.org/10.1093/aje/kwaa195.

    Article  Google Scholar 

  12. Brawarsky P, Neville BA, Fitzmaurice GM, Earle C, Haas JS. Surveillance after resection for colorectal cancer. Cancer. 2013;119(6):1235–42. https://doi.org/10.1002/cncr.27852.

    Article  PubMed  Google Scholar 

  13. Fish J, Williamson I. Exploring lesbian, gay and bisexual patients’ accounts of their experiences of cancer care in the UK. Eur J Cancer Care. 2018;27(1):e12501. https://doi.org/10.1111/ecc.12501.

    Article  Google Scholar 

  14. Fish J, Williamson I, Brown J. Disclosure in lesbian, gay and bisexual cancer care: towards a salutogenic healthcare environment. BMC Cancer. 2019;19(1):678. https://doi.org/10.1186/s12885-019-5895-7.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lisy K, Peters MDJ, Schofield P, Jefford M. Experiences and unmet needs of lesbian, gay, and bisexual people with cancer care: a systematic review and meta-synthesis. Psycho-Oncology. 2018;27(6):1480–9. https://doi.org/10.1002/pon.4674.

    Article  PubMed  Google Scholar 

  16. Kamen CS, Smith-Stoner M, Heckler CE, Flannery M, Margolies L. Social support, self-rated health, and lesbian, gay, bisexual, and transgender identity disclosure to cancer care providers. Oncol Nurs Forum. 2015;42(1):44–51. https://doi.org/10.1188/15.onf.44-51.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Brown MT, McElroy JA. Unmet support needs of sexual and gender minority breast cancer survivors. Support Care Cancer. 2018;26(4):1189–96. https://doi.org/10.1007/s00520-017-3941-z.

    Article  PubMed  Google Scholar 

  18. Jabson JM, Kamen CS. Sexual minority cancer survivors' satisfaction with care. J Psychosoc Oncol. 2016;34(1-2):28–38. https://doi.org/10.1080/07347332.2015.1118717.

    Article  PubMed  Google Scholar 

  19. Kamen CS, Alpert A, Margolies L, Griggs JJ, Darbes L, Smith-Stoner M, et al. "Treat us with dignity": a qualitative study of the experiences and recommendations of lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients with cancer. Support Care Cancer. 2019;27(7):2525–32. https://doi.org/10.1007/s00520-018-4535-0.

    Article  PubMed  Google Scholar 

  20. Boehmer U, Clark MA, Ozonoff A, Winter M, Potter J. Survivors’ perceptions of quality of colorectal cancer care by sexual orientation. Am J Clin Oncol. 2020;43(9):660–6. https://doi.org/10.1097/coc.0000000000000732.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Boehmer U, Miao X, Ozonoff A. Health behaviors of cancer survivors of different sexual orientations. Cancer Causes Control. 2012;23(9):1489–96. https://doi.org/10.1007/s10552-012-0023-x.

    Article  PubMed  Google Scholar 

  22. Boehmer U, Gereige J, Winter M, Ozonoff A. Cancer survivors’ access to care and quality of life: do sexual minorities fare worse than heterosexuals? Cancer. 2019;125(9):3079–85.

    Article  Google Scholar 

  23. Ford ME, Sterba KR, Armeson K, Malek AM, Knight KD, Zapka J. Factors influencing adherence to recommended colorectal cancer surveillance: experiences and behaviors of colorectal cancer survivors. J Cancer Educ. 2019;34(5):938–49. https://doi.org/10.1007/s13187-018-1398-5.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Carpentier MY, Vernon SW, Bartholomew LK, Murphy CC, Bluethmann SM. Receipt of recommended surveillance among colorectal cancer survivors: a systematic review. J Cancer Surviv. 2013;7(3):464–83. https://doi.org/10.1007/s11764-013-0290-x.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Chrischilles EA, McDowell BD, Rubenstein L, Charlton M, Pendergast J, Juarez GY, et al. Survivorship care planning and its influence on long-term patient-reported outcomes among colorectal and lung cancer survivors: the CanCORS disease-free survivor follow-up study. J Cancer Surviv. 2015;9(2):269–78. https://doi.org/10.1007/s11764-014-0406-y.

    Article  PubMed  Google Scholar 

  26. Chaudhry S, Jin L, Meltzer D. Use of a self-report-generated Charlson Comorbidity Index for predicting mortality. Med Care. 2005;43(6):607–15.

    Article  Google Scholar 

  27. Feldman JM, Waterman PD, Coull BA, Krieger N. Spatial social polarisation: using the Index of Concentration at the Extremes jointly for income and race/ethnicity to analyse risk of hypertension. J Epidemiol Community Health. 2015;69(12):1199–207. https://doi.org/10.1136/jech-2015-205728.

    Article  PubMed  Google Scholar 

  28. Krieger N, Waterman PD, Spasojevic J, Li W, Maduro G, Van Wye G. Public health monitoring of privilege and deprivation with the Index of Concentration at the Extremes. Am J Public Health. 2016;106(2):256–63. https://doi.org/10.2105/ajph.2015.302955.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A short scale for measuring loneliness in large surveys: results from Two population-based studies. Res Aging. 2004;26(6):655–72. https://doi.org/10.1177/0164027504268574.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32(6):705–14.

    Article  CAS  Google Scholar 

  31. Kelley DE, Kent EE, Litzelman K, Mollica MA, Rowland JH. Dyadic associations between perceived social support and cancer patient and caregiver health: an actor-partner interdependence modeling approach. Psycho-oncology. 2019;28:1453–60. https://doi.org/10.1002/pon.5096.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Stuber J, Galea S, Ahern J, Blaney S, Fuller C. The association between multiple domains of discrimination and self-assessed health: a multilevel analysis of Latinos and blacks in four low-income New York City neighborhoods. Health Serv Res. 2003;38(6p2):1735–60.

    Article  Google Scholar 

  33. Carver C. You want to measure coping but your protocol's too long: consider the Brief COPE. Int J Behav Med. 1997;4(1):92–100.

    Article  CAS  Google Scholar 

  34. Wagnild GM, Young HM. Development and psychometric evaluation of the Resilience Scale. J Nurs Meas. 1993;1(2):165–78.

    CAS  PubMed  Google Scholar 

  35. Ayanian JZ, Zaslavsky AM, Arora NK, Kahn KL, Malin JL, Ganz PA, et al. Patients' experiences with care for lung cancer and colorectal cancer: findings from the Cancer Care Outcomes Research and Surveillance Consortium. J Clin Oncol. 2010;28(27):4154–61. https://doi.org/10.1200/jco.2009.27.3268.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Martinez KA, Snyder CF, Malin JL, Dy SM. Patient-reported quality of care and pain severity in cancer. Palliat Support Care. 2015;13(4):875–84. https://doi.org/10.1017/s1478951514000777.

    Article  PubMed  Google Scholar 

  37. Sabatino SA, Thompson TD, Smith JL, Rowland JH, Forsythe LP, Pollack L, et al. Receipt of cancer treatment summaries and follow-up instructions among adult cancer survivors: results from a national survey. J Cancer Surviv. 2013;7(1):32–43. https://doi.org/10.1007/s11764-012-0242-x.

    Article  PubMed  Google Scholar 

  38. Kupfer SS, Lubner S, Coronel E, Pickhardt PJ, Tipping M, Graffy P, et al. Adherence to postresection colorectal cancer surveillance at National Cancer Institute-designated comprehensive cancer centers. Cancer Med. 2018;7(11):5351–8. https://doi.org/10.1002/cam4.1678.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Balasubramanian BA, Jetelina KK, Bowen M, Santini NO, Lee SC. Surveillance for colorectal cancer survivors in an integrated safety-net health system in the United States. Int J Care Coord. 2018;21(1-2):26–35. https://doi.org/10.1177/2053434518764634.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Kamen C, Blosnich JR, Lytle M, Janelsins MC, Peppone LJ, Mustian KM. Cigarette smoking disparities among sexual minority cancer survivors. Prev Med Rep. 2015;2:283–6. https://doi.org/10.1016/j.pmedr.2015.04.004.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Jacobsen PB, DeRosa AP, Henderson TO, Mayer DK, Moskowitz CS, Paskett ED, et al. Systematic review of the impact of cancer survivorship care plans on health outcomes and health care delivery. J Clin Oncol. 2018;36(20):2088–100. https://doi.org/10.1200/jco.2018.77.7482.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Salz T, Baxi S. Moving survivorship care plans forward: focus on care coordination. Cancer Med. 2016;5(7):1717–22. https://doi.org/10.1002/cam4.733.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Arora NK, Reeve BB, Hays RD, Clauser SB, Oakley-Girvan I. Assessment of quality of cancer-related follow-up care from the cancer survivor's perspective. J Clin Oncol. 2011;29(10):1280–9. https://doi.org/10.1200/jco.2010.32.1554.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kenzik KM. Health care use during cancer survivorship: review of 5 years of evidence. Cancer. 2019;125(5):673–80. https://doi.org/10.1002/cncr.31852.

    Article  PubMed  Google Scholar 

  45. Vargas GM, Sheffield KM, Parmar AD, Han Y, Brown KM, Riall TS. Physician follow-up and observation of guidelines in the post treatment surveillance of colorectal cancer. Surgery. 2013;154(2):244–55. https://doi.org/10.1016/j.surg.2013.04.013.

    Article  PubMed  Google Scholar 

  46. Hawkins NA, Berkowitz Z, Rodriguez J, Miller JW, Sabatino SA, Pollack LA. Examining adherence with recommendations for follow-up in the prevention among colorectal cancer survivors study. Oncol Nurs Forum. 2015;42(3):233–40. https://doi.org/10.1188/15.Onf.233-240.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Gomez SL, Shariff-Marco S, DeRouen M, Keegan TH, Yen IH, Mujahid M, et al. The impact of neighborhood social and built environment factors across the cancer continuum: current research, methodological considerations, and future directions. Cancer. 2015;121(14):2314–30. https://doi.org/10.1002/cncr.29345.

    Article  PubMed  Google Scholar 

  48. Gorey KM, Luginaah IN, Bartfay E, Fung KY, Holowaty EJ, Wright FC, et al. Effects of socioeconomic status on colon cancer treatment accessibility and survival in Toronto, Ontario, and San Francisco, California, 1996-2006. Am J Public Health. 2011;101(1):112–9. https://doi.org/10.2105/ajph.2009.173112.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Gorey KM, Luginaah IN, Holowaty EJ, Zou G, Hamm C, Bartfay E, et al. Effects of being uninsured or underinsured and living in extremely poor neighborhoods on colon cancer care and survival in California: historical cohort analysis, 1996-2011. BMC Public Health. 2012;12:897. https://doi.org/10.1186/1471-2458-12-897.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was supported by the National Cancer Institute at the National Institutes of Health (1R01CA181392-01A1).

Author information

Authors and Affiliations

  1. Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, Boston, MA, 02118, USA

    Ulrike Boehmer

  2. Harvard Medical School, Boston, MA, USA

    Jennifer Potter & Al Ozonoff

  3. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Jennifer Potter

  4. The Fenway Institute, Boston, MA, USA

    Jennifer Potter

  5. Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA

    Melissa A. Clark

  6. Brown University School of Public Health, Providence, RI, USA

    Melissa A. Clark

  7. Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA

    Michael Winter & Flora Berklein

  8. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Rachel M. Ceballos

  9. Boston University School of Medicine, Boston, MA, USA

    Kevan Hartshorn

  10. Boston Children’s Hospital, Boston, MA, USA

    Al Ozonoff

Authors
  1. Ulrike Boehmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer Potter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Melissa A. Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Winter
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Flora Berklein
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rachel M. Ceballos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kevan Hartshorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Al Ozonoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ulrike Boehmer.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boehmer, U., Potter, J., Clark, M.A. et al. Follow-up surveillance among colorectal cancer survivors of different sexual orientations. J Cancer Surviv 16, 445–454 (2022). https://doi.org/10.1007/s11764-021-01039-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-021-01039-1

Keywords

Search

Navigation