The role of patient experiences with care in older adult colorectal cancer patients with comorbid chronic conditions

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Project Summary Older adults living with chronic conditions and diagnosed with colorectal cancer (CRC) experience substandard cancer care, declines in care for their chronic conditions, and increased mortality relative to CRC patients with no additional chronic conditions. Given compounded disparities in care for racial/ethnic minority patients, non- white older adult CRC patients with comorbid chronic conditions experience even more disparate care and outcomes. Yet, little has been done to systematically seek to improve care and outcomes for this vulnerable patient group. One relatively simple solution may be to seek to optimize patients’ experiences with their care. Patients reporting better experiences with their care have greater adherence to care, improved outcomes, and decreased mortality amenable to healthcare. This research seeks to use Surveillance, Epidemiology, and End Results (SEER)-Consumer Assessment of Healthcare Providers and Systems (CAHPS) data to study the associations between patient experiences and health care, outcomes, and costs in a racially and ethnically diverse sample of older adult CRC patients with comorbid chronic conditions. Our specific aims are to determine racial/ethnic differences in: 1) associations between patient experiences with care and changes in chronic condition care use following CRC diagnosis in older adult patients; 2) effect modification of patient experiences with care in the relationships between comorbidity status and receiving guideline CRC care and CRC survivorship; and 3) associations between patient experiences with care and overall costs of care following CRC diagnosis in patients with and without comorbid chronic conditions. We hypothesize that, in a population-based and nationally representative cohort, older adult CRC patients with comorbid chronic conditions will have better outcomes when experiences with care are highly-rated, and that there will be disparities in these effects for racial/ethnic minority patients. Data for this research will come from the SEER- CAHPS linked dataset, using a sample of Medicare fee-for-service CRC patients with comorbid congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease, or type 2 diabetes who responded to a CAHPS patient experience survey. The findings of this research will inform how we might optimize care for this vulnerable patient group and for the growing group of older adults with multimorbidity. Completion of this project will be aligned with a fellowship training plan with the goals of: 1) training in epidemiologic, health services, and health disparities research; 2) understanding multimorbidity in older adults and health disparities in later life; and 3) integrated longitudinal clinical training in primary care for medically underserved patients. This training will be conducted at the University of Southern California Keck School of Medicine (KSOM) with the support of skilled research and clinical mentors, ample research and clinical training resources, and involvements in structured training programs (such as the KSOM MD/PhD program; the Cancer Research, Education and Engagement Health Equity Center (CaRE2); and the KSOM Primary Care Program).