Delay to Adjuvant Chemotherapy: Survival and Recurrence in Patients of Rectal Cancer Treated with Neo-adjuvant Chemoradiotherapy and Surgery

Thong, Da Wei; Kim, Jason; Naik, Arun; Lu, Cu-Tai; Nolan, Gregory; Papen, Micheal Von

doi:10.1007/s12029-019-00312-y

Cited by 8 publications

(7 citation statements)

References 21 publications

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“…An important novel finding of our study is the finding that delays in initiation beyond the median time point of 59 days were associated with decrements in OS. While this has not been previously described in CCA, there are a number of malignancies in which delay to adjuvant therapy has been shown to be associated with worse outcomes [ 28 , 35 , 36 ]. However, in pancreatic ductal adenocarcinoma, the EPSAC-3 showed that completion of chemotherapy rather than early initiation was prognostic, and there was no survival decrement with delay of inititiation up to 12 weeks [ 37 ].…”

Section: Discussionmentioning

confidence: 89%

The Implications of Treatment Delays in Adjuvant Therapy for Resected Cholangiocarcinoma Patients

Parsons

Lloyd

Johnson

et al. 2022

J Gastrointest Canc

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Purpose The purpose of this study is to understand factors associated with timing of adjuvant therapy for cholangiocarcinoma and the impact of delays on overall survival (OS). Methods Data from the National Cancer Database (NCDB) for patients with non-metastatic bile duct cancer from 2004 to 2015 were analyzed. Patients were included only if they underwent surgery and adjuvant chemotherapy and/or radiotherapy (RT). Patients who underwent neoadjuvant or palliative treatments were excluded. Pearson’s chi-squared test and multivariate logistic regression analyses were used to assess the distribution of demographic, clinical, and treatment factors. After propensity score matching with inverse probability of treatment weighting, OS was compared between patients initiating therapy past various time points using Kaplan Meier analyses and doubly robust estimation with multivariate Cox proportional hazards modeling. Results In total, 7,733 of 17,363 (45%) patients underwent adjuvant treatment. The median time to adjuvant therapy initiation was 59 days (interquartile range 45–78 days). Age over 65, black and Hispanic race, and treatment with RT alone were associated with later initiation of adjuvant treatment. Patients with larger tumors and high-grade disease were more likely to initiate treatment early. After propensity score weighting, there was an OS decrement to initiation of treatment beyond the median of 59 days after surgery. Conclusions We identified characteristics that are related to the timing of adjuvant therapy in patients with biliary cancers. There was an OS decrement associated with delays beyond the median time point of 59 days. This finding may be especially relevant given the treatment delays seen as a result of COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s12029-022-00820-4.

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Section: Discussionmentioning

confidence: 89%

The Implications of Treatment Delays in Adjuvant Therapy for Resected Cholangiocarcinoma Patients

Parsons

Lloyd

Johnson

et al. 2022

J Gastrointest Canc

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“…Other factors may have influenced this change in the treatment of rectal cancer patients other than the delayed diagnosis of cancer. In addition, the surgical delay could compromise resectability and, in the case of rectal cancer, the possibility of neoadjuvant radiotherapeutic treatment 7,8,25 . Previous data revealed higher therapeutic delay in rectal cancer than in colon cancer 26 …”

Section: Discussionmentioning

confidence: 99%

“…7 Moreover, in patients with rectal cancer, delaying neo/adjuvant chemotherapy will lower their DFS and increase their risk of local and distant recurrence. 8 Our aim was to determine the impact of the SARS-CoV-2 pandemic on the diagnosis, prognosis, and management of CRC in Spain by analyzing the differences in CRC staging and treatment received before and after the onset of the pandemic in Spain. Moreover, we have analyzed the effect of SARS-CoV-2 preprocedural PCR testing on the return to the normal colonoscopy activity during pandemic.…”

Section: Introductionmentioning

confidence: 99%

Effect of the SARS‐CoV‐2 pandemic on colorectal cancer diagnosis and prognosis

Medina‐Prado,

Sala‐Miquel,

Aicart‐Ramos

et al. 2024

Cancer Medicine

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Background and Study AimsOur aim was to determine the impact of the SARS‐CoV‐2 pandemic on the diagnosis and prognosis of colorectal cancer (CRC).Patients and MethodsThis prospective cohort study included individuals diagnosed with CRC between March 13, 2019 and June 20, 2021 across 21 Spanish hospitals. Two time periods were compared: prepandemic (from March 13, 2019 to March 13, 2020) and pandemic (from March 14, 2020 to June 20, 2021, lockdown period and 1 year after lockdown).ResultsWe observed a 46.9% decrease in the number of CRC diagnoses (95% confidence interval (CI): 45.1%–48.7%) during the lockdown and 29.7% decrease (95% CI: 28.1%–31.4%) in the year after the lockdown. The proportion of patients diagnosed at stage I significantly decreased during the pandemic (21.7% vs. 19.0%; p = 0.025). Centers that applied universal preprocedure SARS‐CoV‐2 PCR testing experienced a higher reduction in the number of colonoscopies performed during the pandemic post‐lockdown (34.0% reduction; 95% CI: 33.6%–34.4% vs. 13.7; 95% CI: 13.4%–13.9%) and in the number of CRCs diagnosed (34.1% reduction; 95% CI: 31.4%–36.8% vs. 26.7%; 95% CI: 24.6%–28.8%). Curative treatment was received by 87.5% of patients diagnosed with rectal cancer prepandemic and 80.7% of patients during the pandemic post‐lockdown period (p = 0.002).ConclusionsThe COVID‐19 pandemic has led to a decrease in the number of diagnosed CRC cases and in the proportion of stage I CRC. The reduction in the number of colonoscopies and CRC diagnoses was higher in centers that applied universal SARS‐CoV‐2 PCR screening before colonoscopy. In addition, the COVID‐19 pandemic has affected curative treatment of rectal cancers.

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“…While this has not been previously described in CCA, there are a number of malignancies in which delay to adjuvant therapy has been shown to be associated with worse outcomes. 28,35,36 However, in pancreatic ductal adenocarcinoma, the EPSAC-3…”

Section: Discussionmentioning

confidence: 99%

The Implications of Treatment Delays In Adjuvant Therapy For Resected Cholangiocarcinoma Patients

Parsons

Lloyd

Johnson

et al. 2021

Preprint

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Purpose: To understand factors associated with timing of adjuvant therapy for cholangiocarcinoma and the impact of delays on overall survival (OS).Methods: Data from the National Cancer Database (NCDB) for patients with non-metastatic bile duct cancer from 2004 to 2015 were analyzed. Patients were included only if they underwent surgery and adjuvant chemotherapy and/or radiotherapy (RT). Patients who underwent neoadjuvant or palliative treatments were excluded. Pearson’s chi-squared test and multivariate logistic regression analyses were used to assess the distribution of demographic, clinical, and treatment factors. After propensity-score matching with inverse probability of treatment weighting, OS was compared between patients initiating therapy past various time points using Kaplan Meier analyses and doubly-robust estimation with multivariate Cox proportional hazards modeling.Results: In total, 7,733 of 17,363 (45%) patients underwent adjuvant treatment. The median time to adjuvant therapy initiation was 59 days (interquartile range 45-78 days). Age over 65, black and Hispanic race, and treatment with RT alone were associated with later initiation of adjuvant treatment. Patients with larger tumors and high grade disease were more likely to initiate treatment early. After propensity score weighting, there was an OS decrement to initiation of treatment beyond the median of 59 days after surgery. Conclusions: We identified characteristics that are related to the timing of adjuvant therapy in patients with biliary cancers. There was an OS decrement associated with delays beyond the median time point of 59 days. This finding may be especially relevant given the treatment delays seen as a result of COVID-19.

show abstract

Delay to Adjuvant Chemotherapy: Survival and Recurrence in Patients of Rectal Cancer Treated with Neo-adjuvant Chemoradiotherapy and Surgery

Cited by 8 publications

References 21 publications

The Implications of Treatment Delays in Adjuvant Therapy for Resected Cholangiocarcinoma Patients

The Implications of Treatment Delays in Adjuvant Therapy for Resected Cholangiocarcinoma Patients

Effect of the SARS‐CoV‐2 pandemic on colorectal cancer diagnosis and prognosis

The Implications of Treatment Delays In Adjuvant Therapy For Resected Cholangiocarcinoma Patients

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