Engaging primary care physicians is critical in the screening and diagnosis of colorectal cancer at safety-net hospital systems

Katrina Dimaano; Millicent Croman; Stefania Montero; Isabela Sandigo-Saballos; Manuel Orellana; Nikhil Chervu; Beverley A Petrie; Hanjoo Lee

doi:10.1016/j.sopen.2023.12.001

Engaging primary care physicians is critical in the screening and diagnosis of colorectal cancer at safety-net hospital systems

Surg Open Sci. 2023 Dec 21:17:6-10. doi: 10.1016/j.sopen.2023.12.001. eCollection 2024 Jan.

Authors

Katrina Dimaano¹, Millicent Croman¹, Stefania Montero¹, Isabela Sandigo-Saballos¹, Manuel Orellana¹, Nikhil Chervu², Beverley A Petrie¹, Hanjoo Lee¹

Affiliations

¹ Department of Surgery, Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
² Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.

Abstract

Background: Primary care physicians (PCP) play a key role in offering colorectal cancer (CRC) screenings, particularly amongst underserved populations. Given potential delays in or omission of CRC screening in the absence of a PCP, we aimed to determine stage of CRC at diagnosis in an underserved population.

Methods: A retrospective chart review was conducted at two Los Angeles County safety-net hospitals. Inclusion criteria were a CRC diagnosis between 2018 and 2021 and age between 50 and 75 years at diagnosis time. The primary outcome was the cancer stage at diagnosis.

Results: A total of 373 patients were included, of those, 52.5 % had a PCP. Compared to others, PCP was similar in age, racial composition, and primary spoken language (Table 1). Of patients with a PCP, 52.0% were diagnosed by screening. After screening, the most common indication for colonoscopy were blood per rectum (24.9 %) and imaging findings (18.0 %). Patients with a PCP had a significantly lower rate of late stage CRC than those without a PCP (42.4 % vs. 68.0 %, p < 0.001). After adjustment, having a PCP was associated with significantly reduced odds of late stage CRC (Adjusted Odds Ratio 0.83, 95 % Confidence Interval [0.68-1.04]). Having a PCP was not associated with any adjusted increase in number of adenomas or tumor size.

Conclusions: Patients with a PCP, irrespective of undergoing screening, were diagnosed at earlier CRC stages. This underlines the crucial role of PCPs in CRC and diagnosis, reinforcing the need for their active involvement in these processes.

Keywords: Colorectal Cancer; Primary care physician; Screening.