Patient Age and Comorbidity Are Major Determinants of Adjuvant Chemotherapy Use for Stage III Colon Cancer in Routine Clinical Practice

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]

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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

BMJ Open Quality ◽

10.1136/bmjoq-2020-000934 ◽

2021 ◽

Vol 10 (1) ◽

pp. e000934

Author(s):

Arielle Elkrief ◽

Genevieve Redstone ◽

Luca Petruccelli ◽

Alla'a Ali ◽

Doneal Thomas ◽

...

Keyword(s):

Colon Cancer ◽

Clinical Practice ◽

Adjuvant Chemotherapy ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Cox Regression ◽

Health Centre ◽

Stage Iii ◽

Stage Iii Colon Cancer ◽

Mcgill University

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.

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Delivery and effectiveness of adjuvant therapy for stage III colon cancer in routine clinical practice.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.15_suppl.e14540 ◽

2014 ◽

Vol 32 (15_suppl) ◽

pp. e14540-e14540 ◽

Cited By ~ 1

Author(s):

Valerie Heong ◽

Michael Jefford ◽

Hui-Li Wong ◽

Joseph James McKendrick ◽

Jayesh Desai ◽

...

Keyword(s):

Colon Cancer ◽

Clinical Practice ◽

Adjuvant Therapy ◽

Routine Clinical Practice ◽

Stage Iii ◽

Stage Iii Colon Cancer

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Effectiveness of Adjuvant Fluorouracil in Clinical Practice: A Population-Based Cohort Study of Elderly Patients With Stage III Colon Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2002.03.083 ◽

2002 ◽

Vol 20 (19) ◽

pp. 3992-3998 ◽

Cited By ~ 115

Author(s):

Theodore J. Iwashyna ◽

Elizabeth B. Lamont

Keyword(s):

Colon Cancer ◽

Cohort Study ◽

General Population ◽

Survival Benefit ◽

Population Based ◽

Stage Iii ◽

Medicare Beneficiaries ◽

Patient Age ◽

Stage Iii Colon Cancer ◽

Patient Âgé

PURPOSE: Although randomized controlled trials (RCTs) consistently show that adjuvant fluorouracil (5-FU) extends the survival of patients with stage III colon cancer, it is not yet known whether this benefit exists in populations underrepresented on clinical trials, particularly the elderly with medical comorbidity treated in the community. In this study, we ask the following: (1) What is the hazard of death associated with adjuvant 5-FU in the general population of elderly stage III colon cancer patients? (2) Does the hazard vary with patient age? PATIENTS AND METHODS: In this prospective, nonrandomized, population-based cohort study of 3,357 elderly Medicare beneficiaries who had undergone resection of stage III colon cancer according to the Surveillance, Epidemiology, and End-Results registries, we use propensity score matching to compare the all-cause mortality of patients who received 5-FU to matched untreated patients. RESULTS: 5-FU reduces the hazard of death by 27% (hazard ratio, 0.73; 95% confidence interval [CI], 0.65 to 0.82) across the 6 years of our data in a Cox model. At 5 years, 52.7% (95% CI, 49.6% to 55.6%) of the treated and 40.7% (95% CI, 38.1% to 43.4%) of the matched untreated are still alive. We find that these effects do not diminish with advancing patient age. CONCLUSION: The survival benefit of adjuvant 5-FU that has been demonstrated in participants of RCTs is also evident in a population sample of elderly Medicare beneficiaries with stage III colon cancer treated in the community. Furthermore, this survival benefit does not appear to diminish with patient age. These findings support the continued use of adjuvant 5-FU in the general population of elderly patients with stage III colon cancer and suggest that oncologists in the community are practicing at a high level of effectiveness.

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