Determining the Optimal Timing for Initiation of Adjuvant Chemotherapy After Resection for Stage II and III Colon Cancer

Sun, Zhifei; Adam, Mohamed A.; Kim, Jina; Nussbaum, Daniel P.; Benrashid, Ehsan; Mantyh, Christopher R.; Migaly, John

doi:10.1097/dcr.0000000000000518

Cited by 49 publications

(47 citation statements)

References 23 publications

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“…An encouraging finding of this study is that despite the higher R0 resection rate, an excellent 5-year overall survival rate of 67% was demonstrated in the neoadjuvant group. This is similar to the survival in the control group (65%) and comparable to recent literature [37][38][39]. Most importantly, these results are in accordance with the first results of the randomized phase FOxTROT trial that were presented at the ASCO annual meeting 2019.…”

Section: Discussionsupporting

confidence: 91%

Neoadjuvant Chemotherapy for Locally Advanced T4 Colon Cancer: A Nationwide Propensity-Score Matched Cohort Analysis

et al. 2019

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Introduction: Neoadjuvant chemotherapy (CT) for locally advanced colon cancer (LACC) could potentially lead to tumor shrinkage, eradication of micrometastases, and prevention of tumor cell shedding during surgery. This retrospective study investigates the surgical and oncological outcomes of preoperative CT for LACC. Methods: Using the Netherlands Cancer Registry, data of patients with stage II or III colon cancer, diagnosed between 2008 and 2016 was collected. A propensity score matching (PSM; 1:2) was performed and compared patients with clinical tumor (cT) 4 colon cancer who were treated with neoadjuvant CT to patients with cT4 colon cancer treated with adjuvant CT (Fig. 1). Results: A total of 192 patients treated with neoadjuvant CT were compared to 1,954 patients that received adjuvant CT. After PSM, 149 patients in the neoadjuvant group were compared to 298 patients in the control group. No significant differences were found in baseline characteristics after PSM. After neoadjuvant CT, a significant response was observed in 13 (9%) patients with 5 (4%) patients showing a complete response. Complete resection margins (R0) were achieved in 77% in the neoadjuvant group versus 86% in the adjuvant treated group (p = 0.037). Significantly less tumor positive lymph nodes were found in the neoadjuvant group (median 0 vs. 2, p < 0.001). Major complication rates and 5-year overall survival did not differ between both groups (67–65%, p = 0.87). Conclusion: Neoadjuvant CT seems safe and feasible with similar long-term survival compared to patients who are treated with adjuvant CT.

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Section: Discussionsupporting

confidence: 91%

Neoadjuvant Chemotherapy for Locally Advanced T4 Colon Cancer: A Nationwide Propensity-Score Matched Cohort Analysis

et al. 2019

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“…Time cutoffs defining a delay in adjuvant chemotherapy initiation have varied from one month to three months in previous studies [ 5 - 19 ], and a time delay in chemotherapy has been reported to adversely influence [ 5 , 7 , 10 , 11 , 14 - 17 , 19 ] or not influence the oncologic outcome (Table 1 ) [ 6 , 8 , 9 , 12 , 13 , 18 ]. It is still controversial whether a delay in chemotherapy negatively influences oncologic outcomes.…”

Section: Introductionmentioning

confidence: 99%

The impact of delayed commencement of adjuvant chemotherapy (eight or more weeks) on survival in stage II and III colon cancer: a national population-based cohort study

et al. 2017

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BackgroundTo examine the impact of chemotherapy delay on survival in patients with stage II or III colon cancer and the factors associated with the delay (≥8 weeks) of adjuvant chemotherapy.MethodsPatients undergoing curative resection and adjuvant chemotherapy in a national population-based cohort were included.ResultsAmong 5355 patients, 154 (2.9%) received chemotherapy more than 8 weeks after surgery. Based on a multivariate analysis, the risk factors associated with chemotherapy delay ≥8 weeks were older age [65 to 74 years (hazard ratio [HR]=1.48) and ≥75 years (HR=1.69), p=0.0354], medical aid status in the health security system (HR=1.76, p=0.0345), and emergency surgery (HR=2.43, p=0.0002). Using an 8-week cutoff, the 3-year overall survival rate was 89.62% and 80.98% in the <8 weeks and ≥8 weeks groups, respectively (p=0.008). Independent prognostic factors for inferior overall survival included chemotherapy delay ≥8 weeks (HR=1.49, p=0.0365), older age [65 to 74 years (HR=1.94) and ≥75 years (HR=3.41), p<0.0001], TNM stage III (HR=2.46, p<0.0001), emergency surgery (HR=1.89, p<0.0001), American Society of Anesthesiologists score of 3 or higher (HR=1.50, p<0.0001), and higher transfusion amounts (HR=1.09, p=0.0392).ConclusionsThis study shows that delayed commencement of adjuvant chemotherapy, defined as ≥ 8 weeks, is associated with inferior overall survival in colon cancer patients with stage II or III disease. The delay to initiation of adjuvant chemotherapy is influenced by several multidimensional factors, including patient factors (older age), insurance status (medical aid), and treatment-related factors (emergency surgery).

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“…Smooth transition to postoperative adjuvant chemotherapy is critical in colorectal cancer treatment. Although currently there is no consensus on the exact time to initiate adjuvant chemotherapy, it is generally agreed that the start time of chemotherapy should be no later than 8 weeks after operation [5][6][7][8][9]. The potential reasons for the delay of chemotherapy generally lie in the following aspects: patient-related factors such as lower socioeconomic status, female gender, and older age; treatmentrelated factors such as postoperative complications, surgical approach (open vs laparoscopic), and chemotherapy reagents; social and psychological factors such as lack of insurance, lack of social support, and insufficient knowledge on chemotherapy [10,[19][20][21][22].…”

Section: Discussion Of the Resultsmentioning

confidence: 99%

“…A systematic and meta-analysis involving 15,410 colorectal patients demonstrated that a 4-week increment in time to adjuvant chemotherapy was associated with a 14% decrease in both overall survival (OS) and disease-free survival (DFS) [6]. Another two large-scale retrospective studies from the US and Netherlands National Cancer Database also showed that a delay of 6-8 weeks between surgery and adjuvant therapy would reduce survival in stage II and III colorectal cancer patients [7,8].…”

Section: Introductionmentioning

confidence: 99%

High level of unmet needs and anxiety are associated with delayed initiation of adjuvant chemotherapy for colorectal cancer patients

Zhu

Tong

et al. 2020

Support Care Cancer

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Aims Adjuvant chemotherapy is recommended for patients with curatively resected colorectal cancer. The aim of this study is to evaluate the impact of unmet supportive care needs and anxiety on the initiation of postoperative adjuvant chemotherapy in colorectal cancer patients. Methods This is a retrospective study from a single tertiary referral hospital. Patients diagnosed with colorectal cancer who met the inclusion criteria were included. The Hospital Anxiety and Depression Scale (HADS) and modified 34-item Supportive Care Needs Survey (SCNS-SF34) were applied to assess patient's anxiety level and unmet needs. The time intervals between initiation of adjuvant chemotherapy and operation were recorded. Factors associated with delayed initiation of chemotherapy were investigated in univariate and multivariate analysis. Results A total of 135 patients with colorectal cancer were included. In total, 16.3% (22/135) and 5.2% (7/135) reported symptoms of anxiety and depression. In multivariate analysis, low to moderate income status, postoperative complications, anxiety, and high level of unmet needs are independent risk factors for late initiation of chemotherapy. Conclusions Our findings showed that psychological problems such as anxiety and high unmet supportive needs are correlated with delayed initiation of adjuvant chemotherapy in colorectal cancer patients.

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Determining the Optimal Timing for Initiation of Adjuvant Chemotherapy After Resection for Stage II and III Colon Cancer

Cited by 49 publications

References 23 publications

Neoadjuvant Chemotherapy for Locally Advanced T4 Colon Cancer: A Nationwide Propensity-Score Matched Cohort Analysis

Neoadjuvant Chemotherapy for Locally Advanced T4 Colon Cancer: A Nationwide Propensity-Score Matched Cohort Analysis

The impact of delayed commencement of adjuvant chemotherapy (eight or more weeks) on survival in stage II and III colon cancer: a national population-based cohort study

High level of unmet needs and anxiety are associated with delayed initiation of adjuvant chemotherapy for colorectal cancer patients

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