Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States.

BACKGROUND: Clinical practice guidelines recommend colonoscopies at regular intervals for colorectal cancer (CRC) survivors. Using data from a large, multi-regional, population-based cohort, we describe the rate of surveillance colonoscopy and its association with geographic, sociodemographic, clinical, and health services characteristics. METHODS: We studied CRC survivors enrolled in the Cancer Care Outcomes Research and Surveillance (CanCORS) study. Eligible survivors were diagnosed between 2003 and 2005, had curative surgery for CRC, and were alive without recurrences 14 months after surgery with curative intent. Data came from patient interviews and medical record abstraction. We used a multivariate logit model to identify predictors of colonoscopy use. RESULTS: Despite guidelines recommending surveillance, only 49% of the 1423 eligible survivors received a colonoscopy within 14 months after surgery. We observed large regional differences (38% to 57%) across regions. Survivors who received screening colonoscopy were more likely to: have colon cancer than rectal cancer (OR = 1.41, 95% CI: 1.05-1.90); have visited a primary care physician (OR = 1.44, 95% CI: 1.14-1.82); and received adjuvant chemotherapy (OR = 1.75, 95% CI: 1.27-2.41). Compared to survivors with no comorbidities, survivors with moderate or severe comorbidities were less likely to receive surveillance colonoscopy (OR = 0.69, 95% CI: 0.49-0.98 and OR = 0.44, 95% CI: 0.29-0.66, respectively). CONCLUSIONS: Despite guidelines, more than half of CRC survivors did not receive surveillance colonoscopy within 14 months of surgery, with substantial variation by site of care. The association of primary care visits and adjuvant chemotherapy use suggests that access to care following surgery affects cancer surveillance.

"Suffragettes of the Harem": The Evolution of Sympathy and the Afterlives of Sentimentality in American Feminist Orientalism, 1865-1920

This project examines narrative encounters in space identified as “harem,” produced by authors with biographical ties to the vanguard of the American Suffrage Movement. I regard these feminists’ circulations East, to the domestic space of the Other, as a hitherto unstudied, yet critical component of transnationalism in the history of U.S. Suffrage. This literary record also crucially reveals the extent to which sentimentality was plotted as a potential force for the reform of other cultures. An urge to sympathize denied in the space of the harem illustrates the colonial anxieties that subtended sentimentality’s prospective deployment beyond national borders. In five chapters on the work of Anna Leonowens, Susan Elston Wallace, Demetra Vaka Brown, Charlotte Perkins Gilman, and Edith Wharton, I examine how Suffrage-minded authors writing the harem strategically abandon an activist praxis of fellow feeling. Such a reluctance to transform sentimental literature into a colonial literature consequently informs that genre’s postbellum decline. The sentiments that run dry for American feminists in the harem additionally foreground the costly failures of Wilsonian Idealism, a doctrine that appropriated a discourse of sentimentality in order to script the United States’ expanded involvement in global affairs.