Associations of Demographic and Socioeconomic Factors With Complete Treatment and Follow up of Colon Cancer

esmat davoudi monfared--- Dept. of Community Medicine and Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Mohammad Ali Heidarnia--- Dept. of Community Medicine and Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Mohammad Esmaeil Akbari--- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Parvin Yavari--- Dept. of Community Medicine & Health, Medical School Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Alireza Abadi--- Dept. of Community Medicine & Health, Medical School Shahid Beheshti University of Medical Sciences, Tehran, Iran.



Background: Cancer is the second cause of death in the world, and colon cancer is the third cause of death and is one of the most common cancers which will cure with early diagnosis, treatment and sufficient follow up. Assessing factors which affect this cancer is important for prolonging patient survival. Socioeconomic factors are among effective factors of cancer morbidity and mortality. Because mortality rates for colon cancers vary by socioeconomic characteristics, this study has been performed to recognize the relationship between socioeconomic factors with treatment and follow up of colon cancer.

Methods: This was a cross-sectional, descriptive study for patients with colon cancer registered in Cancer Research Center of Shahid Beheshti University of Medical Sciences from April 2005 to November 2006. Patients were selected randomly, and the study was conducted using questionnaires filled by interviewing the patients via phone (if a patient was dead, the questions were asked from their family members). Data analysis was done using SPSS (version 19) software.

Results: The study was performed on 520 colon cancer patients with age range of 23-88 years. The mean age of the patients was 63 (S.D. = 11.8) and the median age was 64.Two hundred thirty seven (45.4%) patients were female and 283(54.4%) were male. Using Chi- square test, age< 60 (P=0.002) and female gender (P=0.034) had a significant correlation with complete treatment and there was a significant relationship between complete follow up and age< 60 (P=0.037), academic education (P=0.02) and having insurance (P=0.021). Multiple logistic regression tests were used to evaluate concurrent effects of variables on treatment and follow up. Correlated variables to complete treatment include: age< 60 (P=0.001), and female gender The Odds Ratio (OR) of completing treatment for patients under 60 years of age versus patients above 60 years was 3.13 (95% C.I. 1.55 to 6.34), and the OR of completing treatment for women versus men was 1.91(95% C.I. 1.33 to 2.74). Correlated variables to follow up were academic education ( ) and having insurance . The OR of cancer follow up in illiterate patients versus college-educated patients was 0.45(95% C.I. 0.24 to 0.82), and the OR of cancer follow up in patients without insurance versus patients with health was 0.46(95% C.I. 0.21 to 0.98).

Conclusion: Age is a correlated factor on completing colon cancer treatment. Women have more complete colon cancer treatment than men. Academic education and having insurance were the most important factors among socioeconomic factors observed in a five-year follow up after treatment. As the population of the old is increasing, executing effective interventions to improve treatment and follow up procedures for old patients is of prime importance. It seems that increasing the insurance contribution in follow up measures may lead to increase in the regular follow up and may affect patients' survival.

Keywords: Colon cancer; Treatment; Follow-up; Socioeconomic factors; Demography

Please cite this article as: Davoudi Monfared E, Heidarnia MA, Akbari ME, Yavari P, Abadi A. Associations of Demographic and Socioeconomic Factors with Complete Treatment and Follow up of Colon Cancer. Iran J Cancer Prev.2012; 5(4):203-9.


1. Boyle P, Levin B, eds. World Cancer Report 2008. Lyon, France: IARC Press; 2008.

2. Naghavi M. Health manifestation modification in Iran. J of Iranian Epidemiology. 2006; 1(3): 13-25. (Persian)

3.Sadjadi A, Nouraie M, Mohagheghi MA, Mousavi-Jarrahi A, Malekezadeh R, Parkin DM. Cancer occurrence in Iran in 2002, an international perspective. Asian Pac J Cancer Prev. 2005; 6: 359 -63.

4. Shack LG, Rachet B, Brewster DH, Coleman MP. Socioeconomic inequalities in cancer survival in Scotland 1986–2000. Br J Cancer. 2007; 97:999-1004.

5. Woods LM, Rachet B, Coleman MP. Origins of socioeconomic inequalities in cancer survival: a review. Ann Oncol. 2006; 17:5-19.

6. Ionescu MV, Carey F, Tait IS, Steele RJ. Socioeconomic status and stage at presentation of colorectal cancer. Lancet. 1998;352:1439.

7. Vinnakota S, Lam NS. Socioeconomic inequality of cancer mortality in the United States: a spatial data mining approach. Int J Health Geogr. 2006; 5:9.

8. Singh GK, Miller BA, Hankey BF. Area socioeconomic variations in U.S. cancer incidence, mortality, stage, treatment, and survival, 1975–1999. NCI Cancer Surveillance Monograph Series, Number 4 (Publication No. 03-0000). Bethesda, MD: National Cancer Institute, National Institutes of Health, 2003.

9. Wardle J, McCaffery K, Nadel M, Atkin W. Socioeconomic differences in cancer screening participation: comparing cognitive and psychosocial explanations. SocSci Med. 2004; 59: 249-61.

 10. Groome PA, Schulze KM, Keller S, Mackillop WJ. Demographic Differences between Cancer Survivors and those who Die Quickly of their Disease.ClinOncol. 2008; 20: 647-56.

11. Eloranta S, Lambert PC, Cavalli-Bjorkman N, Andersson TM, Glimelius B, Dickman PW. Does socioeconomic status influence the prospect of cure from colon cancer – A population-based study in Sweden 1965–2000.Eur J Cancer. 2010; 46(16): 2965-72.

12. Mehrkhani  F,  Nasiri  S,  Donboli  K,  Meysamie  A, Hedayat  A. Prognostic factors in survival of colorectal cancer patients after surgery. Colorectal Dis.  2009; 11: 157-61.

13. Cooper GS, Yuan Z, Chak A, Rimm AA. Geographic and patient variation among Medicare beneficiaries in the use of follow-up testing after surgery for nonmetastatic colorectal carcinoma. Cancer. 1999; 85:2124-31.

14.  Hillner BE, Penberthy L, Desch CE, McDonald MK, Smith TJ, Retchin SM. Variation in staging and treatment of local and regional breast cancer in the elderly. Breast Cancer Res Treat. 1996; 40:75-86.

15.  Smith TJ, Penberthy L, Desch CE. Differences in initial treatment patterns and outcomes of lung cancer in the elderly.Lung Cancer. 1995;13:235-52.

16. Faivre-Finn C, Bouvier A-M, Phelip J-M. Colon cancer in France: evidence for improvement in management and survival. Gut .2002; 51:60-4.

17. Potosky AL, Harlan LC, Kaplan RS. Age, sex, and racial differences in the use of standard adjuvant therapy for colorectal cancer. J ClinOncol. 2002; 20: 1192-202.

18. Schrag D, Cramer LD, Bach PB, Begg CB. Age and adjuvant chemotherapy use after surgery for stage III colon cancer. J Natl Cancer Inst. 2001; 93:850-7.

19. Gatta G, Sant M, Coebergh JW, Hakulinen T. Substantial variation in therapy for colorectal cancer across Europe: EUROCARE analysis of cancer registry data for 1987. Eur J Cancer. 1996; 32A:831-5.

20. Cooper GS, Yuan Z, Landefeld CS, Rimm AA. Surgery for colorectal cancer: race-related differences in rates and survival among Medicare beneficiaries. Am J Public Health. 1996; 86:582-6.

21. Roetzheim RG, Pal N, Gonzalez EC, Ferrante JM, Van Durme DJ, Krischer JP. Effects of health insurance and race on colorectal cancer treatments and outcome. Am J Public Health. 2000;90:1746-54.

22.Harmon JW, Tang DG, Gordon TA, Bowman HM, Choti MA, Kaufman HS, et al. Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection. Ann Surg. 1999; 230: 404-11; discussion 411-3.

23. Dayal H, Polissar L, Yang CY, Dahlberg S. Race, socioeconomic status, and other prognostic factors for survival from colo-rectal cancer. J Chronic Dis. 1987; 40:85-64.

24. Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey SG. Indicators of socioeconomic position (part 1). J Epidemiol Community Health. 2006; 60:7-12.

25. Albano J, Ward E, Jemal A. Cancer mortality in the United States by education level and race. J Natl Cancer Inst. 2007; 99:1384-94.

26. Ciccone G, Prastaro C, Ivaldi C. Access to hospital care, clinical stage and survival from colorectal cancer according to socio-economic status. Ann Oncol. 2000; 11: 1201-4.

27. Ward E, Halpern M, Schrag N. Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin. 2008; 58:9-31.

28. Gorey KM, Luginaah IN, Bartfay E. 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; 101:112-9.

29. Lafata JE, Johnson CC, Ben-Menachem. Sociodemographic differences in the receipt of colorectal cancer surveillance care following treatment with curative intent. Med Care. 2001; 39(4):361-72.

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