Variation in Delayed Time to Adjuvant Chemotherapy and Disease-Specific Survival in Stage III Colon Cancer Patients

Becerra, Adan Z.; Aquina, Christopher T.; Mohile, Supriya G.; Tejani, Mohamedtaki Abdulaziz; Schymura, Maria J.; Boscoe, Francis P.; Xu, Zhaomin; Justiniano, Carla F.; Boodry, Courtney I.; Swanger, Alex A.; Noyes, Katia; Monson, J. R. T.; Fleming, Fergal J.

doi:10.1245/s10434-016-5622-4

Cited by 22 publications

(16 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This left 34 studies with unique populations for inclusion ( fig 1 , table 1 , table 2 ). 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 These studies included 1 272 681 patients, with a sample size ranging from 174 to 420 792 (appendix 3). Twenty eight studies were population or registry based, and six were institutional reports.…”

Section: Resultsmentioning

confidence: 99%

“… 1 2 3 47 We also note major detrimental effects of prolonged waiting times on cancer specific survival outcomes in 13 of 15 studies included in our meta-analysis that reported cancer survival outcomes alongside overall survival. 14 16 22 28 29 30 31 32 33 34 35 36 38 39 46 These studies span seven treatment indications. Factors associated with medical status such as elements of socioeconomic status or insurance status might also be confounding factors; we found that 91% and 82% of identified studies accounted for these, respectively, though this does not completely rule out the possibility of residual confounding.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Mortality due to cancer treatment delay: systematic review and meta-analysis

Hanna

King

Thibodeau

et al. 2020

BMJ

845

713

View full text Add to dashboard Cite

Objective To quantify the association of cancer treatment delay and mortality for each four week increase in delay to inform cancer treatment pathways. Design Systematic review and meta-analysis. Data sources Published studies in Medline from 1 January 2000 to 10 April 2020. Eligibility criteria for selecting studies Curative, neoadjuvant, and adjuvant indications for surgery, systemic treatment, or radiotherapy for cancers of the bladder, breast, colon, rectum, lung, cervix, and head and neck were included. The main outcome measure was the hazard ratio for overall survival for each four week delay for each indication. Delay was measured from diagnosis to first treatment, or from the completion of one treatment to the start of the next. The primary analysis only included high validity studies controlling for major prognostic factors. Hazard ratios were assumed to be log linear in relation to overall survival and were converted to an effect for each four week delay. Pooled effects were estimated using DerSimonian and Laird random effect models. Results The review included 34 studies for 17 indications (n=1 272 681 patients). No high validity data were found for five of the radiotherapy indications or for cervical cancer surgery. The association between delay and increased mortality was significant (P<0.05) for 13 of 17 indications. Surgery findings were consistent, with a mortality risk for each four week delay of 1.06-1.08 (eg, colectomy 1.06, 95% confidence interval 1.01 to 1.12; breast surgery 1.08, 1.03 to 1.13). Estimates for systemic treatment varied (hazard ratio range 1.01-1.28). Radiotherapy estimates were for radical radiotherapy for head and neck cancer (hazard ratio 1.09, 95% confidence interval 1.05 to 1.14), adjuvant radiotherapy after breast conserving surgery (0.98, 0.88 to 1.09), and cervix cancer adjuvant radiotherapy (1.23, 1.00 to 1.50). A sensitivity analysis of studies that had been excluded because of lack of information on comorbidities or functional status did not change the findings. Conclusions Cancer treatment delay is a problem in health systems worldwide. The impact of delay on mortality can now be quantified for prioritisation and modelling. Even a four week delay of cancer treatment is associated with increased mortality across surgical, systemic treatment, and radiotherapy indications for seven cancers. Policies focused on minimising system level delays to cancer treatment initiation could improve population level survival outcomes.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mortality due to cancer treatment delay: systematic review and meta-analysis

Hanna

King

Thibodeau

et al. 2020

BMJ

845

713

View full text Add to dashboard Cite

show abstract

“…These 34 studies corresponded to the post-hoc analyses of randomized controlled trials and cohorts and to retrospective studies. They included a total of 141,853 patients: 134,701 in the colon cancer cohort, as shown in Table 1 [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]; 5121 in the gastric cancer cohort, as shown in Table 2 [26,27,28,29,30,31]; and 2031 in the pancreatic cancer cohort, as shown in Table 3 [32,33,34,35,36,37]. Among these studies, 22 were used for the colorectal cancer analysis and six were used for pancreatic and gastric cancer each.…”

Section: Resultsmentioning

confidence: 99%

Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-Analysis

Petrelli

Zaniboni

Ghidini

et al. 2019

Cancers

View full text Add to dashboard Cite

(1) Background: The optimal timing of adjuvant chemotherapy (CT) in gastrointestinal malignancies is still a matter of debate. For colorectal cancer, it is recommended to start post-operative treatment within eight weeks. The objective of this study was to assess the clinical effects of starting adjuvant CT within or after 6–8 weeks post-surgery in colorectal, gastric, and pancreatic cancer. (2) Methods: MEDLINE, EMBASE, and the Cochrane Library were searched in December 2018. Publications comparing the outcomes of patients treated with adjuvant CT administered before (early) or after (delayed) 6–8 weeks post-surgery for colorectal, gastric, and pancreatic cancer were identified. The primary endpoint was overall survival (OS). (3) Results: Out of 8752 publications identified, 34 comparative studies assessing a total of 141,853 patients were included. Meta-analysis indicated a statistically significant increased risk of death with delayed CT (>6–8 weeks post-surgery) in colorectal cancer (hazard ratio (HR) = 1.27, 95% confidence interval (CI) 1.21–1.33; p <0.001). Similarly, for gastric cancer, delaying adjuvant CT was associated with inferior overall survival (HR = 1.2, 95% CI 1.04–1.38; p = 0.01). Conversely, the benefit of earlier CT was not evident in pancreatic cancer (HR = 1, 95% CI 1–1.01; p = 0.37). Conclusions: Starting adjuvant CT within 6–8 weeks post-surgery is associated with a significant survival benefit for colorectal and gastric cancer, but not for pancreatic cancer.

show abstract

“…From an oncological perspective, to eliminate microscopic metastasis it appears that AC should be started immediately following curative gastrectomy. PDAC has been reported to be an independent prognostic factor in other types of cancer, with various cutoff values suggested, including 12 weeks [10] and 8 weeks in colon cancer [15][16][17] and 13 weeks (91 days) in breast cancer [18]. With regard to gastric cancer, various cut-off values of PDAC have been reported as prognostic factors, ranging from 4 to 8 weeks [12,16,[19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Prognostic effect of postoperative duration until adjuvant chemotherapy and cumulative S-1 dose in gastric cancer

Takashima¹,

Komatsu²,

Nishibeppu³

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundAdjuvant chemotherapy (AC) following curative gastrectomy for stage II/III gastric cancer (GC) is recommended in Japan. However, for various reasons, patients cannot always start AC at the appropriate time. This study was designed to investigate the effect of the postoperative duration until adjuvant chemotherapy (PDAC) and cumulative S-1 dose on prognosis.MethodsBetween 2008 and 2014, 76 consecutive GC patients who underwent postoperative S-1 monotherapy were enrolled in this study.ResultsPostoperative complications of Clavien–Dindo grade II or higher and postoperative peak C-reactive protein of 8 mg/dl or higher were significantly associated with delayed AC. The cut-off value of PDAC selected to most effectively stratify prognosis was 7 weeks. For relapse-free survival (RFS), patients with PDAC ≥ 7 weeks had an insignificantly poorer prognosis than those with PDAC < 7 weeks (p = 0.017, 5-year RFS: PDAC ≥ 7 weeks vs. PDAC < 7 weeks, 48.5% vs. 77.0%). A multivariate analysis showed that PDAC ≥ 7 weeks [p = 0.007; hazard ratio (HR) 3.99 (95% CI: 1.46–11.5)] and cumulative S-1 dose > 12,000 mg [p = 0.033; HR 0.38 (95% CI: 0.14–0.93)] were independent prognostic factors. In patients with a cumulative S-1 dose ≥ 12,000 mg, there were no prognostic differences between patients with and without PDAC ≥ 7 weeks.Conclusions7 weeks after surgery could be an indicator starting AC. A cumulative S-1 dose of more than 12,000 mg might be a key dose for diminishing the poor prognostic effects of delaying AC.

show abstract

Variation in Delayed Time to Adjuvant Chemotherapy and Disease-Specific Survival in Stage III Colon Cancer Patients

Cited by 22 publications

References 23 publications

Mortality due to cancer treatment delay: systematic review and meta-analysis

Mortality due to cancer treatment delay: systematic review and meta-analysis

Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-Analysis

Prognostic effect of postoperative duration until adjuvant chemotherapy and cumulative S-1 dose in gastric cancer

Contact Info

Product

Resources

About