Use of Adjuvant Chemotherapy and Radiation Therapy for Colorectal Cancer in a Population-Based Cohort

Ayanian, John Z.; Zaslavsky, Alan M.; Fuchs, Charles S.; Guadagnoli, Edward; Creech, Cynthia M.; Cress, Rosemary D.; O’Connor, Lilia; West, Dee W.; Allen, Mark; Wolf, Robert; Wright, William E.

doi:10.1200/jco.2003.06.178

Cited by 286 publications

(225 citation statements)

References 42 publications

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“…Consistent with other studies conducted in the United States, [3][4][5][6][7][8] age was the factor related most significantly to not receiving guideline-recommended treatment after adjusting for comorbidities, although studies have demonstrated that neither the survival advantage 6,23 nor toxicity 23 of adjuvant chemotherapy are related to age in patients with stage III colon adenocarcinoma. Large studies conducted in the United States based on Medicare patients (aged 65 years) diagnosed in the early to middle 1990s indicated that 50% 8 to 55% 5 of patients with stage III colon adenocarcinoma received adjuvant chemotherapy, whereas an estimate for patients who were diagnosed in 2002 3 was 63%.…”

Section: Discussionsupporting

confidence: 82%

“…After a series of studies conducted in the United States that identified patient characteristics associated with not receiving guideline-recommended adjuvant chemotherapy in patients with stage III colon adenocarcinoma, [3][4][5][6][7][8][9] in the current study, we investigated whether similar population-based observations could be made in a similar patient cohort in Alberta. Patient characteristics that were associated with not having a consultation with an oncologist also were investigated.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the survival advantage and the general acceptance of adjuvant chemotherapy as the standard of care, several studies conducted in the United States have indicated that a large proportion of patients do not receive it or experience treatment delays. [3][4][5][6][7][8] To our knowledge, there has only been 1 study conducted in Canada that has measured adherence to guidelines for patients with stage III colon adenocarcinoma. 9 That populationbased study, which covered 3 provinces, indicated that approximately 50% of patients who were diagnosed in 2004 did not receive adjuvant chemotherapy.…”

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confidence: 99%

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Characteristics of patients with stage III colon adenocarcinoma who fail to receive guideline‐recommended treatment

PhD

Hossain

Yasui

et al. 2010

Cancer

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BACKGROUND: Many patients with stage III colon adenocarcinoma do not receive adjuvant chemotherapy despite the proven survival advantage it offers. To enhance the provision of optimal cancer care, patient characteristics associated with not receiving guideline-adherent treatment must be identified among patients with operable, stage III colon adenocarcinoma. METHODS: This was a population-based, retrospective study of all patients who underwent surgery for stage III colon adenocarcinoma diagnosed from 2002 through 2005 in Alberta, Canada. Demographic and treatment information captured in the Alberta Cancer Registry were linked to: 1) hospital discharge data to determine comorbidities, 2) electronic medical records to identify consults with oncologists, and 3) the 2001 Canadian census for neighborhood-level socioeconomic data. Multivariate log-binomial regression models were used to identify patient characteristics that were associated with not having a consultation with a medical oncologist and not receiving adjuvant chemotherapy. RESULTS: Of the 772 patients who underwent surgery for stage III colon adenocarcinoma and met the eligibility criteria, 618 patients (80%) had a consultation with an oncologist. Of those, 388 patients (63%) initiated adjuvant chemotherapy within 84 days of their surgery. Patient characteristics that were associated with not having a consultation with an oncologist were neighborhood income, geography, age, and comorbidities. Of those patients who had a consultation, after adjusting for comorbidities, only older age was related to not receiving adjuvant chemotherapy. CONCLUSIONS: The current results indicated that the proportion of patients with stage III colon adenocarcinoma who did not receive treatment according to evidence-based guidelines was appreciable. The authors concluded that the association of this failure with patient age, geography, and income is concerning and that evaluation of referral patterns and interventions are needed. Cancer 2010;116:4849-56.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Characteristics of patients with stage III colon adenocarcinoma who fail to receive guideline‐recommended treatment

PhD

Hossain

Yasui

et al. 2010

Cancer

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“…[12] There are several explanations why elderly patients receive adjuvant chemotherapy less often than younger patients, such as the presence of comorbidities, unfavourable performance status or patient refusal. [38][39][40] Our study is hampered by the lack of information about comorbidities and performance status of the patient at time of diagnoses. Nevertheless marked differences in performance status of patients between hospitals in the Netherlands have not been reported.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Disparities in quality of care for colon cancer between hospitals in the Netherlands

Elferink

Wouters

Krijnen

et al. 2010

European Journal of Surgical Oncology (EJSO)

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“…4 Regardless of the benefits and survival advantage gained by adjuvant chemotherapy, several studies have demonstrated that large proportions of patients do not receive it or experience treatment delays. [5][6][7][8][9] The objectives of the current study were 1) to quantify the proportion of patients receiving adjuvant chemotherapy within 12 weeks after surgery, 2) to identify factors associated with the receipt of timely adjuvant chemotherapy, and 3) to assess the association between the receipt and timing of initiation of adjuvant chemotherapy and survival among patients who were diagnosed with stage III colon cancer in Alberta between 2000 and 2005.…”

mentioning

confidence: 99%

Association between receipt and timing of adjuvant chemotherapy and survival for patients with stage III colon cancer in Alberta, Canada

Lima

Yasui

Scarfe

et al. 2011

Cancer

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BACKGROUND: Surgery followed by adjuvant chemotherapy has been standard treatment for stage III colon cancer since 1990. However, to date, clinical trials have not been conducted to determine the definitive outer time limit by which adjuvant chemotherapy should be received for optimal survival benefit. The objective of the current study was to assess the association between the receipt/timing of adjuvant chemotherapy and patient survival in clinical practice. METHODS: Residents of Alberta who were diagnosed with stage III colon adenocarcinoma in years 2000 to 2005 who underwent surgery were included in the study. Patients were identified from the Alberta Cancer Registry and were linked to hospital data and neighborhood-level socioeconomic data from the 2001 Canadian Census. Cox proportional hazards models were used to estimate hazard ratios of death according to the timing of chemotherapy. RESULTS: There were 1053 patients in the study; 648 (61%) initiated adjuvant chemotherapy within 16 weeks of surgery. There was no difference in overall survival or colon cancer-specific survival between those who received adjuvant chemotherapy from 8 to 12 weeks postsurgery compared with those who received it within 8 weeks. However, those who received chemotherapy 12 to 16 weeks after surgery and those who either received it >16 weeks after surgery or received no treatment had a 43% and 107% greater risk of dying, respectively, than those who received chemotherapy within 8 weeks of surgery (hazard ratio, 1.43 [95% confidence interval, 0.96-2.13] and hazard ratio, 2.07 [95% confidence interval, 1.56-2.76], respectively). Analyses were controlled for age, year, and region of residence at diagnosis; sex; neighborhood-level socioeconomic factors; and number of comorbidities. CONCLUSIONS: The results from this study were consistent with current guideline recommendations in Alberta that patients with stage III adenocarcinoma should receive chemotherapy within 12 weeks of surgery. Cancer 2011;117:3833-

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Use of Adjuvant Chemotherapy and Radiation Therapy for Colorectal Cancer in a Population-Based Cohort

Cited by 286 publications

References 42 publications

Characteristics of patients with stage III colon adenocarcinoma who fail to receive guideline‐recommended treatment

Characteristics of patients with stage III colon adenocarcinoma who fail to receive guideline‐recommended treatment

Disparities in quality of care for colon cancer between hospitals in the Netherlands

Association between receipt and timing of adjuvant chemotherapy and survival for patients with stage III colon cancer in Alberta, Canada

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