Failure to complete adjuvant chemotherapy is associated with adverse survival in stage III colon cancer patients

Abstract

Two recent North American studies have shown that completion of 5-fluorouracil (5FU)-based adjuvant chemotherapy is a major prognostic factor for the survival of elderly stage III colon cancer patients. The aim of the present study was to confirm this finding in a population-based series from Australia. The study cohort comprised 851 stage III colon cancer patients treated by surgery alone and 461 who initiated the Mayo chemotherapy regime. One-third of patients who initiated chemotherapy failed to complete more than three cycles of treatment. Independent predictors for failure to complete were treatment in district or rural hospitals, low socioeconomic index and treatment by a low-volume surgeon. Patients who failed to complete chemotherapy showed worse cancer-specific survival compared not only to those who completed treatment (HR ¼ 2.24; 95% confidence interval (CI) (1.66 -3.03), Po0.001) but also to those treated by surgery alone (HR ¼ 1.37; 95% CI (1.09 -1.72), P ¼ 0.008). The current and previous studies demonstrate the importance of completing adjuvant 5-FU-based chemotherapy for colon cancer. Further prospective studies are required to identify better the physiological and socioeconomic factors responsible for failure to complete chemotherapy so that appropriate improvements in health service delivery can be made.

Use of guideline‐recommended adjuvant therapies and survival outcomes for people with colorectal cancer at tertiary referral hospitals in South Australia

“…For those who did receive guideline‐recommended care, there were significant stage specific survival benefits when compared with those who did not receive this care. For stage C colon cases, receiving adjuvant therapy was associated with higher survivals, consistent with international and Australian literature . The decreased hazard ratio for rectal cases receiving adjuvant therapy was also consistent with trial results, despite the nonexperimental routine‐practice nature of the treatment environment …”

Surgeons’ Volume of Colorectal Cancer Procedures and Collaborative Decision-Making About Adjuvant Therapies

“…Although we cannot demonstrate causal relationships, such collaboration may contribute to the greater likelihood that patients of high-volume surgeons receive appropriate adjuvant therapies. 18 This collaboration may thus be a partial mediator of greater adherence to evidence-based guidelines for adjuvant therapies observed among patients of high-volume providers of colorectal cancer care.…”

“…6-17 Patients of higher-volume surgeons receive permanent colostomies less frequently and have lower mortality compared with patients of lower-volume surgeons. 7-10, 12, 16 Moreover, volume is significantly associated with use of guideline-recommended therapies, such as adjuvant chemotherapy for node-positive colorectal cancer, 18 and hospital volume is strongly associated with use of adjuvant radiation therapy. 16 These findings raise the question as to how care delivered by higher-volume surgeons following cancer surgery might differ from that of lower-volume surgeons.…”

Tumor-Infiltrating Lymphocytes and Perforation in Colon Cancer Predict Positive Response to 5-Fluorouracil Chemotherapy

“…The hospital records of each case were individually reviewed and only those patients who completed at least four to six cycles with the Mayo regimen of 5-FU/ leucovorin were included in the study (n = 305). Patients who initiated chemotherapy but did not complete at least four cycles were excluded (n = 156) because this was considered to represent subtherapeutic management (11,12). A total of 851 patients were treated by surgery alone.…”