Adherence to Clinical Practice Guidelines for Adjuvant Chemotherapy for Colorectal Cancer in a Canadian Province: A Population-Based Analysis

Abstract

Purpose: Clinical practice guidelines (CPGs) recommend adjuvant chemotherapy after curative-intent surgery for colorectal cancer (CRC). Studies have shown variable rates of adherence to adjuvant therapy CPGs. This study sought to determine the proportion of patients in Nova Scotia receiving CPG-concordant adjuvant chemotherapy within 12 weeks of surgery for CRC in 2001 to 2005, and to identify factors associated with chemotherapy receipt beyond 12 weeks from surgery or chemotherapy nonreceipt. Methods: Patients with stages IIB or III colon or stages II or IIIrectal cancer who underwent curative-intent surgery in Nova Scotia were identified through the provincial cancer registry and anonymously linked to 14 administrative health databases. Chart review was conducted to obtain chemotherapy data and reasons for chemotherapy nonreceipt. Logistic regression was used to identify factors independently associated with receipt of chemotherapy and meeting the 12-week benchmark (P Ͻ .05).Results: A total of 1,151 patients were identified, of whom 59% received chemotherapy. Factors predicting chemotherapy receipt were male sex, age Ͻ 75 years, no hospital readmission within 30 days of surgery, stage III disease, no prior cancer diagnosis, and rectal cancer. Of the 679 patients who received chemotherapy, 479 (72%) met the 12-week benchmark, with male sex, urban residence, less social deprivation, colon cancer and increased length of hospital stay as significant factors. Of the 472 patients who did not receive chemotherapy, the most common reason for nonreceipt was no consultation with a medical oncologist (53%). Conclusion:A number of factors influence adherence to adjuvant chemotherapy CPGs for CRC and should be incorporated in future work as novel regimens enter clinical practice.

Characteristics Affecting Survival after Locally Advanced Colorectal Cancer in Quebec

“…A landmark pooled analysis of trials of fluorouracil-based adjuvant chemotherapy in stage iii colon cancer patients published in 2001 reported a 24% overall mortality reduction across all age groups 29 . The magnitude of the guideline-adherence disparity observed in the present study between patients less than 70 years of age and those 70 or more years of age appears comparable to disparities noted elsewhere in Canada for similar years [30][31][32][33][34] . Our study has several strengths.…”

Better Colon Cancer Care for Extremely Poor Canadian Women Compared with American Women

“…And it may be particularly instructive for Canada-U.S. comparisons among women for these reasons. First, low-income status has been consistently observed to be inversely associated with colon cancer care in the United States, but not in Canada (Gorey, Luginaah, Bartfay, Fung, Holowaty, Wright, Hamm, & Kanjeekal, 2011;Booth, Zhang-Salomons, & Mackillop, 2010;Etzioni, El-Khoueiry, & Beart, 2008;Lima, Yasui, Scarfe, & Winget, 2011;Rayson, Urquhart, Cox, Grunfeld, & Porter, 2012). Second, in the United States, people with private HI or Medicare coverage are more likely to receive the best, evidencebased care and to survive longer than are those with arguably less adequate Medicaid coverage or no coverage (Boland et al, 2013;Bradley, Given, Dahman, & Fitzgerald, 2008).…”

Decision-making by surgeons about referral for adjuvant therapy for patients with non-small-cell lung, breast or colorectal cancer: a qualitative study

“…These areas include development and implementation of provincial standards, improvements in access to multidisciplinary tumour boards and the development of systems that permit "just-in-time" surgeon-oncologist consultation. Such interventions can increase collaborative decision-making 21 and support co-management options for community-based surgeons who do not regularly interact with other cancer specialists. 40 Policy interventions that provide supportive and financial supports to • Patients' beliefs and preferences:* Surgeons' decisions are influenced by patients' beliefs and preferences.…”

“…Across Canada, researchers have observed variations in referral rates and receipt of oncology services for patients with potentially curable cancers. [17][18][19][20][21] Prior research in the province of Nova Scotia showed that a substantial minority of patients with potentially curable non-small-cell lung or colorectal cancer (20%-33%, depending on cancer site and stage) were not referred for an oncology consultation. Background: Because surgeons are the main gatekeepers to oncology services, understanding how they make decisions related to referral for adjuvant therapies is important to optimize referral rates and use of oncology services for patients with potentially curable disease.…”