Patterns of Care for Metastatic XXXX in Appalachia, and the Clinical, Sociodemographic, and Service Provider Determinants.

@entity1 @entity4933 @entity712 @entity5 @entity303 @entity1576 @entity14
BACKGROUND: Appalachia has high @entity14 ( @entity14 ) incidence and mortality, at least in part due to screening disparities. This paper examines patterns and determinants of metastatic @entity14 care. METHODS: @entity14 @entity1 diagnosed in 2006-2008 from 4 @entity5 registries (Kentucky, Ohio, @entity4933 ) were linked to Medicare claims (2005-2009.) The final sample after exclusions included 855 stage IV and 590 stages I-III @entity1 with metachronous or synchronous metastases. We estimate bivariate and multivariate analyses for several surgical and chemotherapeutic strategies of care using clinical, sociodemographic, and contextual determinants. RESULTS: Among 1,445 @entity14 @entity1 , 84% had @entity5 resection and 44% received chemotherapy. Of the chemotherapy @entity1 , 44% received newer systemic agents for at least 75% of the cycles. One year survivors with liver or lung metastases were more likely to have their @entity5 resected immediately (86.1% vs 69.5% for liver, and 78.2% vs 64.9% for lung) and have their metastases resected/ablated (15.7% vs 2.6% for liver and 15.0% vs 0.5% for lung). @entity1 with stages I-III primary @entity5 (versus IV) were much more likely to be resected, but they were less likely to receive chemotherapy. @entity1 with comorbidities ( @entity712 , @entity303 , or @entity1576 ) had lower odds of chemotherapy. Smaller hospital size and surgical volume had higher odds of immediate versus delayed surgery. The newer chemotherapeutic agents were more common with higher surgical volume. CONCLUSIONS: Metastatic @entity14 has clinical, sociodemographic, and service provider determinants.
