Does delay of adjuvant chemotherapy impact survival in patients with resected stage II and III colon adenocarcinoma?

Abstract

BACKGROUND: It is unclear whether delays in commencing adjuvant chemotherapy after surgical resection of colon adenocarcinoma adversely impact survival. METHODS: Patients with stage II-III colon adenocarcinoma who received adjuvant chemotherapy at 2 centers were identified through the institutional tumor registry. Time to adjuvant chemotherapy, overall survival (OS), and relapse-free survival (RFS) were calculated from the day of surgery. Patients were dichotomized into early (time to adjuvant chemotherapy 60 days) and late treatment (time to adjuvant chemotherapy >60 days) groups. OS and RFS were compared using log-rank test and multivariate analysis by the Cox proportional hazards model. RESULTS: Of 186 patients included in the study, 49 (26%) had received adjuvant chemotherapy >60 days after surgical resection. Thirty percent of the delays were system related (eg, late referrals, insurance authorizations). Time to adjuvant chemotherapy >60 days was associated with significantly worse OS in both univariate analysis and a Cox proportional hazards model (hazard ratio, 2.17; 95% confidence interval, 1.08-4.36). Although difference in RFS between the 2 groups favored time to adjuvant chemotherapy <60, this did not reach statistical significance. CONCLUSIONS: Adjuvant chemotherapy delay >60 days after surgical resection of colon cancer is associated with worse OS.

Laparoscopy mitigates adverse oncological effects of delayed adjuvant chemotherapy for colon cancer

“…In the literature, the proportion of patients who have delayed initiation of CT ranges from 20 to 72 % [5][6][7][8]16]. This is consistent with our data, as approximately one third of patients received adjuvant CT greater than 8 weeks after [10] found that the length of postoperative hospital stay, age, and race were associated with initiating CT more than three months following surgery.…”

“…A prospective trial that aggressively planned earlier initiation of adjuvant CT in laparoscopic patients would more appropriately determine if laparoscopy would result in improved outcomes. Decreased OS in patients who receive CT greater than 8 weeks after surgery has been demonstrated in several studies [5,8,9,18]. However, none of the previous studies examined the effect of laparoscopy on survival after delay in CT.…”

“…Adjuvant CT has been shown to increase survival in these patients [3,4]. Previous studies have shown that delaying initiation of adjuvant CT greater than 8 weeks after surgical resection adversely affects overall patient survival [5][6][7][8]. A number of demographic, clinical, and systemic factors have been associated with delay in the initiation of CT, including age, race, and postoperative length of stay [9,10].…”

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

“…Previous investigation of elapsed times to start of adjuvant ther- apy for both breast and lung cancer have observed a number of patient, disease, and system factors influencing elapsed times. 32- 36 We did not observe any significant factors influencing this time for the colon cancer cohort. For the rectal cancer cohort, both rural residence and social deprivation were significantly associated with not meeting this benchmark.…”

S3-Leitlinie – Kolorektales Karzinom

“…Eine kleine retrospektive Studie (n = 186) weist darauf hin, dass der Beginn einer adjuvanten Therapie später als 60 Tage nach der Operation zu einem verschlechterten Gesamtüberleben führen kann [871] In einer weiteren retrospektiven Analyse (1997 -2012) wird untersucht, ob der Zeitpunkt des Beginns einer adjuvanten Therapie (< oder > 8 Wo.) oder eine erforderliche Reoperation Einfluss auf die Prognose haben [873].…”