Factors Affecting Use and Delay (≥8 Weeks) of Adjuvant Chemotherapy after Colorectal Cancer Surgery and the Impact of Chemotherapy-Use and Delay on Oncologic Outcomes

Kim, Ik Yong; Kim, Bo Ra; Kim, Young Wan

doi:10.1371/journal.pone.0138720

Cited by 57 publications

(45 citation statements)

References 27 publications

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“…A delay in the initiation of systemic therapy for patients undergoing major liver surgery is in keeping with the literature that shows that major hepatectomies are associated with greater morbidity and post‐operative complications compared with minor liver resections for CRLMs . Similarly, our finding of a trend toward a delay in the initiation of chemotherapy in patients with high ASA scores is in line with a recent study by Kim et al, which demonstrated that ASA class ≥3 was associated with not receiving chemotherapy in patients undergoing resection of stage II and III colorectal cancers. ASA class ≥3 has also been associated with an increased rate of post‐operative complications in patients undergoing laparoscopic colorectal surgery .…”

Section: Discussionsupporting

confidence: 92%

“…ASA class ≥3 has also been associated with an increased rate of post‐operative complications in patients undergoing laparoscopic colorectal surgery . Kim et al also found that the presence of post‐operative complications was associated with a delay of chemotherapy ≥8 weeks, and as was stated, both ASA class ≥3 and major liver surgery have been associated with increased post‐operative complications …”

Section: Discussionmentioning

confidence: 89%

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The effect of a simultaneous versus a staged resection of metastatic colorectal cancer on time to adjuvant chemotherapy

Souder

Azin

Wood

et al. 2018

Journal of Surgical Oncology

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 89%

The effect of a simultaneous versus a staged resection of metastatic colorectal cancer on time to adjuvant chemotherapy

Souder

Azin

Wood

et al. 2018

Journal of Surgical Oncology

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“…[11][12][13][14]24 We found that the frequency of chemotherapy administration was significantly lower in patients with $2 comorbidities, which agrees with findings from previous studies. 20,21,23,25 However, strong associations between age and chemotherapy nonreceipt persisted even after comprehensive adjustment for this important covariate. Chemotherapy use at older age was even substantially lower in recent years than in earlier time periods.…”

Section: Discussionmentioning

confidence: 95%

“…Potential underuse of chemotherapy in elderly patients with colon cancer has been reported in previous studies. [20][21][22][23][24][25]33 However, these studies were mostly registrybased [20][21][22][23][24]33 and therefore largely limited in terms of other potentially influential factors associated with chemotherapy use that they could have considered. This population-based study aimed to provide important and comprehensive insight into possible patient-and hospital-based determinants of chemotherapy administration.…”

Section: Discussionmentioning

confidence: 99%

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Decreasing Use of Chemotherapy in Older Patients With Stage III Colon Cancer Irrespective of Comorbidities

Walter

Boakye

Weberpals

et al. 2019

Journal of the National Comprehensive Cancer Network

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Background: Chemotherapy underuse in elderly patients (aged ≥75 years) with colon cancer has been reported in previous studies. However, these studies were mostly registry-based and limited in their potential to consider underlying reasons of such undertreatment. This study aimed to evaluate patient and hospital determinants of chemotherapeutic treatment in patients with stage III colon cancer, with a particular focus on age and underlying reasons for nontreatment of elderly patients. Methods: A total of 629 patients with stage III colon cancer who were diagnosed in 2003 through 2012 and recruited into a population-based study in the Rhine-Neckar region of Germany were included. Information on sociodemographic and lifestyle factors, comorbidities, and treatment was collected from patient interviews and physicians. Patient (with an emphasis on age) and hospital factors were evaluated for their associations with administration of adjuvant chemotherapy overall and of oxaliplatin specifically using multivariable logistic regression. Results: Administration of chemotherapy decreased from 94% in patients aged 30 to 64 years to 51% in those aged ≥75 years. A very strong decline in chemotherapy use with age persisted even after comprehensive adjustment for multiple patient factors—including comorbidities—and hospital factors and was also seen among patients without any major comorbidities. Between 2005 and 2008, and 2009 and 2012, chemotherapy administration in patients aged ≥75 years decreased from 60% to 41%. Among chemotherapy recipients, old age was also strongly associated with higher odds of nonadministration of oxaliplatin. The 2 most commonly reported reasons for chemotherapy nonreceipt among the study population were patient refusal (30%) and old age (24%). Conclusions: Age was the strongest predictor of chemotherapy underuse, irrespective of comorbidities and even in patients without comorbidities. Such underuse due just to older age in otherwise healthy patients deserves increased attention in clinical practice to ensure that elderly patients also get the best possible care. Patients’ refusal as the most frequent reason for chemotherapy nonreceipt also warrants further investigation to exclude misinformation as underlying cause.

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Impact of type and severity of postoperative complications on long‐term outcomes after colorectal liver metastases resection

Fernández-Moreno

Dorcaratto

Garcés-Albir

et al. 2020

Journal of Surgical Oncology

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Background and Objectives Postoperative complications (POCs) after hepatic resection for colorectal liver metastases (CRLM) adversely affect long‐term survival. The aim of this study was to analyze the effect of POC etiology and severity on overall survival (OS) and disease‐free survival (DFS). Methods A retrospective study of 254 consecutive hepatectomies for CRLM was performed. Univariate and multivariate analyses were performed to determine the effects of demographic, tumor‐related and perioperative variables on OS and DFS. A 1:1 propensity score matching (PSM) was then used to compare patients with different POC etiology: infective (Inf‐POC), noninfective (Non‐inf POC), and no‐complications (No‐POC). Results Inf‐POC, Non‐inf POC, and No‐POC patients represented 18.8%, 19.2%, and 62% of the sample, respectively. In univariate and multivariate analyses infectious POC were independent risk factors for decreased OS and DFS. After PSM, Inf‐POC group presented decreased OS and DFS when compared with Non‐inf POC (5‐year OS 31.8% vs 51.6%; P = .05 and 5‐year DFS 13.6% vs 31.9%; P = .04) and with No‐POC (5‐year OS 29.4% vs 58.7%; P = .03 and 5‐year DFS 11.8% vs 39.7%; P = .03). There were no differences between Non‐inf POC and No‐POC patients. POC severity calculated using the Comprehensive Complications Index did not influence OS and DFS before and after PSM. Conclusion The negative oncological impact of POCs after CRLM resection is determined by infective etiology not by severity.

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Factors Affecting Use and Delay (≥8 Weeks) of Adjuvant Chemotherapy after Colorectal Cancer Surgery and the Impact of Chemotherapy-Use and Delay on Oncologic Outcomes

Cited by 57 publications

References 27 publications

The effect of a simultaneous versus a staged resection of metastatic colorectal cancer on time to adjuvant chemotherapy

The effect of a simultaneous versus a staged resection of metastatic colorectal cancer on time to adjuvant chemotherapy

Decreasing Use of Chemotherapy in Older Patients With Stage III Colon Cancer Irrespective of Comorbidities

Impact of type and severity of postoperative complications on long‐term outcomes after colorectal liver metastases resection

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