Use and Effectiveness of Adjuvant Chemotherapy for Stage III Colon Cancer: A Population-Based Study

Booth, Christopher M.; Nanji, Sulaiman; Wei, Xuejiao; Peng, Yingwei; Biagi, James; Hanna, Timothy P.; Krzyzanowska, Monika K.; Mackillop, William J.

doi:10.6004/jnccn.2016.0006

Cited by 54 publications

(55 citation statements)

References 12 publications

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“…[1][2][3] Despite robust evidence, it is well known that not all patients will receive guideline-concordant care. Only 66% of patients in Ontario received adjuvant chemotherapy 4 ; comparable rates have been reported elsewhere. [5][6][7] Interpretation of this data is limited by the fact that the optimal utilization rate is not known.…”

Section: Introductionsupporting

confidence: 63%

“…The study population included 2801 patients with resected stage III colon cancer (Figure , Table ). Our previous analysis showed that older patients with greater comorbidity were less likely to receive ACT; surgeon/hospital volumes were not associated with ACT utilization . There were total of 72 hospitals where patients had surgery.…”

Section: Resultsmentioning

confidence: 97%

“…Our previous analysis showed that older patients with greater comorbidity were less likely to receive ACT; surgeon/hospital volumes were not associated with ACT utilization. 4 There were total of 72 hospitals where patients had surgery. Fourteen were classified as teaching hospitals, 13 were comprehensive cancer centers, and 32 were hospitals with medical oncology services on site.…”

Section: Study Populationmentioning

confidence: 99%

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Estimating the optimal rate of adjuvant chemotherapy utilization for stage III colon cancer

et al. 2019

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Background Identifying optimal chemotherapy utilization rates can drive improvements in quality of care. We report a benchmarking approach to estimate the optimal rate of adjuvant chemotherapy (ACT) for stage III colon cancer. Methods The Ontario Cancer Registry and linked treated records were used to identify ACT utilization. Monte Carlo simulation was used to estimate the proportion of ACT rate variation that could be due to chance alone. The criterion‐based benchmarking approach was used to explore whether socioeconomic or system‐level factors were associated with ACT. We also used the “pared‐mean” approach to identify a benchmark population of hospitals with the highest ACT rates. Results The study population included 2801 patients; ACT was delivered to 66% (1861/2801). Monte Carlo simulation suggested that the observed component of variation (15.6%) in ACT rates was within the 95% CI (11.5%‐17.3%) of what could be expected due to chance alone; the nonrandom component of ACT rate variation across hospitals was only 1.5%. There was no difference in hospital ACT rate by teaching status (P = .107), cancer center status (P = .362), or having medical oncology on site (P = .840). Unadjusted ACT rates varied across hospitals (range 44%‐91%, P = .017). The unadjusted benchmark ACT rate was 81% (95%CI 76%‐86%); utilization rate in non‐benchmark hospitals was 65% (95%CI 63%‐66%). However, after adjusting for case mix, the difference in ACT utilization between benchmark and non‐benchmark populations was significantly smaller. Conclusions We did not find any system‐level factors associated with the utilization of ACT. Our results suggest that the observed variation in hospital ACT rate is not significantly different from variation due to chance alone. Using the “pared‐mean” approach may significantly overestimate optimal treatment rates if case mix is not considered.

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Section: Introductionsupporting

confidence: 63%

Section: Resultsmentioning

confidence: 97%

Section: Study Populationmentioning

confidence: 99%

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Estimating the optimal rate of adjuvant chemotherapy utilization for stage III colon cancer

et al. 2019

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“…Furthermore, there is evidence from Ontario that new forms of adjuvant treatment are used more frequently in richer communities. 20,21 Thus, it seems probable that the more rapid adoption of effective new treatments in richer communities may be responsible for the observed increase in disparity in cancer-specific survival associated with socioeconomic status.…”

Section: Discussionmentioning

confidence: 99%

Temporal trends in the association between socioeconomic status and cancer survival in Ontario: a population-based retrospective study

et al. 2017

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“…[862]. In dieser retrospektiven Analyse profitierten alle Altersgruppen von einer adjuvanten Chemotherapie.…”

Section: Multiviszerale Resektionunclassified

S3-Leitlinie – Kolorektales Karzinom

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Buchberger

Follmann³

et al. 2017

Z Gastroenterol

151

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Use and Effectiveness of Adjuvant Chemotherapy for Stage III Colon Cancer: A Population-Based Study

Abstract: One-third of patients with stage III colon cancer in the general population do not receive ACT. Use of ACT in routine practice is associated with a substantial improvement in CSS and OS.

Cited by 54 publications

References 12 publications

Estimating the optimal rate of adjuvant chemotherapy utilization for stage III colon cancer

Estimating the optimal rate of adjuvant chemotherapy utilization for stage III colon cancer

Temporal trends in the association between socioeconomic status and cancer survival in Ontario: a population-based retrospective study

S3-Leitlinie – Kolorektales Karzinom

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