1. 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

2. Disclosures We have no disclosures

3. 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

4. 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

5. 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

6. 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

7. 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)

8. NSABP Participating Sites Methods

9. 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)

10. Years of Treatment Trial Accrual C-07 Methods

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. LTS-01 Participation Rates

18. Demographics Variables LTS-01 N= 708 NHIS N= 2124 Gender Male57.1% 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% Hispanic Yes No 3.8% 96.2% 10.2% 89.8%

19. 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% <0.0001 Married75.9%54.6%<0.0001 Health insurance99.0%93.3%<0.0001 Private insurance76.1%66.5%<0.0001

20. LTS-01 and NHIS Comorbidities

21. Health Behaviors Health Behavior LTS-01 N= 708 NHIS N= 2124 p-value Have a usual source of care97.7%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 months67.5%44.3%<0.0001

22. Factors associated with Usual Source of Care PredictorsOdds Ratio 95% Wald Confidence Limits p-value Health insurance 7.554.47 to 12.73< 0.0001 Diabetes 6.702.42 to 18.530.0002 Private insurance 2.111.35 to 3.310.0010 LTS-01 1.791.04 to 3.090.0369 Age 1.331.10 to 1.620.0039 Male 0.670.46 to 0.970.0328

23. Factors Associated with Flu Shot PredictorsOdds Ratio 95% Wald Confidence Limits p-value Health Insurance 2.991.84 to 4.85<0.0001 LTS-01 2.882.35 to 3.53<0.0001 Age 2.322.10 to 2.57<0.0001 Diabetes 2.231.74 to 2.86<0.0001 Heart disease1.761.36 to 2.28<0.0001 Lung disease 1.521.18 to 1.960.0011 Education 1.141.04 to 1.250.0040 Male 0.740.63 to 0.890.0009 Hispanic 0.670.49 to 0.920.0140

24. Cancer Screening Screening TestLTS-01NHIS 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

25. 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%

26. LTS-01 Cancer Surveillance and Survivorship

27. 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

28. 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

29. Implications Clinical trials as a source of long-term survivor information Further results of LTS-01 patient-reported outcomes to follow

31. Extra slides

32. Factors Associated with ER Use PredictorsOdds Ratio 95% Wald Confidence Limits p-value LTS-01 1.180.95 to 1.470.1298 Education 0.870.79 to 0.950.0037 Heart Disease 1.401.09 to 1.800.0079 Stroke 1.921.39 to 2.65<0.0001 Chronic Lung Disease 1.571.22 to 2.010.0005 Diabetes 1.281.00 to 1.640.0464 Kidney Disease 1.470.99 to 2.170.0573 Bowel Disease 1.611.21 to 2.150.0011

33. Cancer Screening by Age: Pap smear

34. Cancer Screening by Age: Mammogram

35. Cancer Screening by Age: PSA test