Reasons for delay in timely administration of adjuvant chemotherapy for patients with stage III colon cancer: a multicentre cohort study from the McGill University Department of Oncology

PurposeAdjuvant chemotherapy within 56 or 84 days following curative resection is globally accepted as the standard of care for stage III colon cancer as it has been associated with improved overall survival. Initiation of adjuvant chemotherapy within this time frame is therefore recommended by clinical practice guidelines, including the European Society for Medical Oncology. The objective of this study was to evaluate adherence to these clinical practice guidelines for patients with stage III colon cancer across the Rossy Cancer Network (RCN); a partnership of McGill University’s Faculty of Medicine, McGill University Health Centre, Jewish General Hospital and St Mary’s Hospital Center.Patients and methods187 patients who had been diagnosed with stage III colon cancer and received adjuvant chemotherapy within the RCN partner hospitals from 2012 to 2015 were included. Patient and treatment information was retrospectively determined by chart review. Χ2 and Wilcoxon rank-sum tests were used to measure associations and a multivariate Cox regression model was used to determine risk factors contributing to delays in administration of adjuvant chemotherapy.ResultsThe median turnaround time between surgery and adjuvant chemotherapy was 69 days. Importantly, only 27% of patients met the 56-day target, and 71% met the 84-day target. Increasing age, having more than one surgical complication and being diagnosed between 2013–2014 and 2014–2015 reduced the likelihood that patients met these targets. Furthermore, delays were observed at most intervals from surgery to first adjuvant chemotherapy treatment.ConclusionOur study found that within these academic hospital settings, 27% of patients met the 56-day target, and 71% met the 84-day target. Delays were associated with hospital, surgeon and patient-related factors. Initiatives in quality improvement are needed in order to improve adherence to recommended treatment guidelines for prompt administration of adjuvant chemotherapy for stage III colon cancer.

Download Full-text

Adherence to Clinical Practice Guidelines and Colorectal Cancer Survival: A Retrospective High-Resolution Population-Based Study in Spain

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17186697 ◽

2020 ◽

Vol 17 (18) ◽

pp. 6697

Author(s):

Francisco Carrasco-Peña ◽

Eloisa Bayo-Lozano ◽

Miguel Rodríguez-Barranco ◽

Dafina Petrova ◽

Rafael Marcos-Gragera ◽

...

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Clinical Practice ◽

Adjuvant Chemotherapy ◽

High Resolution ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Population Based ◽

Population Based Study ◽

Stage Iii Colon Cancer

Colorectal cancer (CRC) is the third most common cancer worldwide. Population-based, high-resolution studies are essential for the continuous evaluation and updating of diagnosis and treatment standards. This study aimed to assess adherence to clinical practice guidelines and investigate its relationship with survival. We conducted a retrospective high-resolution population-based study of 1050 incident CRC cases from the cancer registries of Granada and Girona, with a 5-year follow-up. We recorded clinical, diagnostic, and treatment-related information and assessed adherence to nine quality indicators of the relevant CRC guidelines. Overall adherence (on at least 75% of the indicators) significantly reduced the excess risk of death (RER) = 0.35 [95% confidence interval (CI) 0.28–0.45]. Analysis of the separate indicators showed that patients for whom complementary imaging tests were requested had better survival, RER = 0.58 [95% CI 0.46–0.73], as did patients with stage III colon cancer who underwent adjuvant chemotherapy, RER = 0.33, [95% CI 0.16–0.70]. Adherence to clinical practice guidelines can reduce the excess risk of dying from CRC by 65% [95% CI 55–72%]. Ordering complementary imagining tests that improve staging and treatment choice for all CRC patients and adjuvant chemotherapy for stage III colon cancer patients could be especially important. In contrast, controlled delays in starting some treatments appear not to decrease survival.

Download Full-text

Adherence to clinical practice guidelines for adjuvant chemotherapy for colorectal cancer in Uruguay: A population-based study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.3_suppl.53 ◽

2021 ◽

Vol 39 (3_suppl) ◽

pp. 53-53

Author(s):

Santiago Fontes ◽

Ana Marín-Jiménez ◽

Megan Berry ◽

Mauricio Cuello ◽

Juan Carlos Sánchez ◽

...

Keyword(s):

Colorectal Cancer ◽

Clinical Practice ◽

Adjuvant Chemotherapy ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Population Based ◽

Stage Iii ◽

Disease Stage ◽

Curative Intent ◽

Factors Associated

53 Background: Despite surgery, the 5-year risk of systemic recurrence of colorectal cancer (CRC) in the absence of any further therapy is approximately 50 % for those with lymph node involvement and 20 ─ 30 % if the lymph nodes are negative. Adjuvant chemotherapy contributes to improved disease-free and overall survival for node-positive (stage III) or high-risk node negative (stage IIB) colon cancer. Similar benefits are observed for adjuvant chemoradiotherapy in rectal cancer. Previous research shows varied rates of adherence to published adjuvant chemotherapy Clinical Practice Guidelines (CPGs) for CRC, although population-based data is scarce. Purpose: The aim of this analysis was to assess adherence rates to adjuvant chemotherapy prescription within 16 weeks of surgery according to local and international CPGs for CRC patients treated with curative intent between 2008 and 2019 at the Uruguayan National Cancer Institute. Data regarding factors associated with chemotherapy receipt beyond 16 weeks from surgery and chemotherapy non receipt was also retrieved and analysed. Methods: We retrospectively reviewed medical and pathology reports of 833 patients diagnosed with CRC at our institution. Patients with stages IIB or III CRC who underwent curative-intent surgery were identified and included in the present analysis. A 16-week benchmark timeline for treatment initiation from date of surgery was considered. Fisher’s exact test was used to determine factors independently associated with receipt of chemotherapy and meeting the 16-week benchmark (p 0.05). Results: A total of 400 patients were identified of which 72% had peritoneal colorectal tumors and 28% had sub-peritoneal rectal tumors. Approximately 70% of the latter group received neoadjuvant chemo-radiotherapy. Considering the total cohort, 61% received adjuvant chemotherapy. Factors predicting chemotherapy receipt in the peritoneal colorectal group were age ≤ 70 and stage III disease. In the sub-peritoneal rectal group no significant effect was found. The 16-week benchmark was met in 72% (175) of those receiving chemotherapy and 70.6% (167) completed 6 months of systemic adjuvant treatment. A total of 156 patients (39%) did not receive adjuvant chemotherapy. The factors predicting chemotherapy non receipt were age > 70 and stage IIB in the peritoneal colorectal group. Conclusions: This analysis of adherence to CPGs identified several factors associated with chemotherapy non receipt and chemotherapy receipt outside of timeline benchmarks from date of curative-intent surgery in Montevideo, Uruguay. The two main factors significantly associated with chemotherapy non receipt were advanced age and lower disease stage. To our knowledge, our data is the first to elucidate these specific factors in the Uruguayan CRC patient population.

Download Full-text

Utilization of adjuvant chemotherapy in “ideal candidates” with stage III colon cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.4103 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 4103-4103

Author(s):

Mohsin Soleja ◽

Suleyman Yasin Goksu ◽

Nina Niu Sanford ◽

Muhammad Shaalan Beg ◽

Radhika Kainthla ◽

...

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Socioeconomic Factors ◽

Cox Regression ◽

The United States ◽

Stage Iii ◽

Categorical Variables ◽

Cox Regression Analysis ◽

Factors Associated ◽

Stage Iii Colon Cancer

4103 Background: Prior studies have observed under-utilization of adjuvant chemotherapy (ACT) in stage III colon cancer. Our aims were to observe the rate of utilization of ACT in very healthy or “ideal candidates”, identify reasons for omission and socioeconomic factors associated with ACT use, and observe patient outcomes. Methods: We queried patients from the National Cancer Database (NCDB) with stage III colon cancer, age<65, and Charlson-Deyo score of 0 who underwent resection in the United States between 2004-2015. Patients who received ACT were compared to patients who had surgery only (SO). We used chi-square test for categorical variables, Kaplan-Meier and Cox regression method for survival analyses. Results: Out of 243,388 stage III colon cancer patients during the study time, a total of 49,046 patients met the specific criteria of “ideal candidate”. Out of these, 88.5% received ACT and 11.5% underwent SO. The primary reason for chemotherapy omission was: no reason given (54.2%), patient/guardian refusal (26.7%), physician recommended against (9.3%), patient died (3%), unknown (6.7%). Patients who received ACT were more likely to be female, non-Hispanic white, have a higher level of education, travel shorter distance for cancer treatment, have private insurance or higher income as compared to counterpart ( all p<.001). Patients who received ACT had significantly better overall survival (5-year survival rate 74% vs. 54%, p<.001). This persisted after multivariable Cox regression analysis [HR:0.48 (CI:0.45-0.50), p<.001]. Conclusions: We observed a high rate of utilization (88.5%) of ACT in patients with stage III colon cancer who were under age 65 and without comorbidities. However, the omission of chemotherapy in this population remains a problem, partially due to patient refusal. Socioeconomic factors associated with lower utilization were primarily related to insurance status (private vs non-private). Patients who received ACT had significantly improved survival as compared to SO group. [Table: see text]

Download Full-text

Understanding why some people with stage III colon cancer do not receive adjuvant chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e14608 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e14608-e14608

Author(s):

Valerie Heong ◽

Hui-Li Wong ◽

Jeanne Tie ◽

Michael Jefford ◽

Kathryn Maree Field ◽

...

Keyword(s):

Colon Cancer ◽

Clinical Practice ◽

Adjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Age Groups ◽

Routine Clinical Practice ◽

Stage Iii ◽

Stage Iii Colon Cancer ◽

N2 Disease ◽

Co Morbidity

e14608 Background: Adjuvant chemotherapy is a standard of care for patients (pts) with stage III colon cancer. While many retrospective series have concluded that treatment is underutilised in routine clinical practice, particularly in older pts, reasons for this remain unexplored. Methods: Data was collected on all pts with stage III colon cancer attending four community hospitals in Australia between January 2003 and July 2012. Every patient was referred to a medical oncologist. For each case where adjuvant therapy was not delivered, reason(s) were prospectively documented by clinicians in a consensus database. Results: Data was collected on 875 pts. Median age 67 years (range 15 - 92). Overall, 147 (25.9%) did not receive adjuvant therapy. Comorbidity was the main reason for non-treatment in all age groups. Age alone was the reason for not recommending treatment in a small number of elderly pts (n=20, 20.4%). Risk of recurrence (N1 vs N2 disease) did not impact recommendations of clinicians (75% vs 76%) or pt acceptance (92% vs 93%). Pts with a lower socioeconomic status were less likely to be offered treatment; however this reflected greater comorbidity in these pts. Treatment acceptance was similar across all socioeconomic groups (data not shown). Conclusions: In routine clinical practice adjuvant chemotherapy should be recommended to, and can be safely delivered to a very high proportion of younger patients. Clinicians are comfortable recommending adjuvant chemotherapy to older pts, with co-morbidity the dominant reason that treatment was not recommended for pts >65 years. The rate of pts declining treatment increased with age, and further study of the factors involved in treatment refusal should be pursued [Table: see text]

Download Full-text

Benefit of oxaliplatin in stage III colon cancer according to IDEA risk groups: Analysis of MOSAIC and C-07 trials.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.118 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 118-118

Author(s):

Ofer Margalit ◽

Ben Boursi ◽

Manel Rakez ◽

Thierry André ◽

Greg Yothers ◽

...

Keyword(s):

Colon Cancer ◽

High Risk ◽

Adjuvant Chemotherapy ◽

Cox Regression ◽

Disease Free Survival ◽

Risk Groups ◽

Low Risk ◽

Stage Iii ◽

Free Survival ◽

Stage Iii Colon Cancer

118 Background: The IDEA pooled analysis compared 3 to 6 months of adjuvant chemotherapy for stage III colon cancer. The overarching goal was to reduce chemotherapy-related toxicity, mainly oxaliplatin-induced neuropathy. Patients were classified into low-risk and high-risk, suggesting low-risk patients may be offered only 3 months of treatment. In our previously published analysis using retrospective data from the National Cancer Database (NCDB) we showed similar benefit for oxaliplatin in both low and high IDEA risk groups. In the current study, we aimed to test our hypothesis using data from the two large clinical trials assessing the benefit of oxaliplatin in the adjuvant setting, namely, MOSAIC and C-07. Methods: Using the MOSAIC and C-07 previously published studies, we identified 1,754 low-risk and 1,302 high-risk individuals with stage III colon cancer, according to the IDEA classification. We used multivariate COX regression to evaluate the magnitude of survival differences between IDEA risk groups, according to oxaliplatin use. The analysis was adjusted for age, primary tumor sidedness, tumor stage, tumor grade and lymph node ratio. Results: Individuals with IDEA low-risk derived overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS) benefit from the addition of oxaliplatin to adjuvant chemotherapy, with adjusted hazard ratios (HRs) of 0.78 (0.65-0.94), 0.75 (0.63-0.89) and 0.74 (0.62-0.90). Similarly, individuals with IDEA high-risk derived OS, DFS and RFS benefit from the addition of oxaliplatin to adjuvant chemotherapy, with adjusted HRs of 0.84 (0.71-0.99), 0.81 (0.69-0.95) and 0.82 (0.69-0.97). Conclusions: IDEA risk classification per se does not predict benefit from addition of oxaliplatin to adjuvant chemotherapy in stage III colon cancer, according to analysis of the MOSAIC and C-07 studies. Funding: NCI U10CA-180868, NCI U10CA-180822.

Download Full-text