Timeliness of adjuvant chemotherapy (AT) for stage III adenocarcinoma of colon (CC): A measure of quality of care.
282 Background: In the past three decades multiple clinical trials have proven the benefit of AT for CC, establishing combination chemotherapy after recovery from surgery as a quality measure in stage III CC. The majority of clinical trials require enrollment for AT within eight weeks from surgery nonetheless there is no established standard time for delivery of AT. Timeliness of service is defined as one of the domains of quality care by Institute of Medicine. We explore the timing of AT as a quality measure in patients (pts) with CC. Methods: We conducted a retrospective analysis of pts with CC who underwent surgery in Los Angeles County Hospital between January 2005 through December of 2009, with at least six months of follow up after surgery. Pt, disease and treatment characteristics were recorded. Disease free survival (DFS) was measured as the time from surgery to the last follow up or recurrence. Results: 52 pts, median age 58 years (28 – 86), 62% female, 65% Hispanics, 21% Asian, 6% black and 6% white, with CC were included all of whom received adjuvant FOLFOX. 24 pts had right and 26 left-sided cancers. Median start day for AT was 60 days after surgery (12-145 days), with 60% waiting more than 8 and 19% more than 12 weeks. 4 pts received 6, 1 pt 10, 2 pts 11 and 45 pts 12 cycles of therapy. 17 pts had recurrence, 3 local and 14 systemic. Median DFS was 25.3 month (range 8-70). In univariable analysis only age was a predictor of recurrence (HR 0.96 95% CI 0.92-0.99). Time from surgery to adjuvant chemotherapy was not a predictor of recurrence (systemic, local and combined), or DFS. Conclusions: In several meta-analyses time form surgery to AT is identified as an independent risk factor for death from colon cancer. In this study there was no association between time from surgery to AT and DFS. Delivery of AT depends on several factors including recovery from surgery, medical oncology visit, placement of a central line, and initiation of the treatment. Quality measures to assess each of these processes can improve the adherence to available data and improve enrollment on clinical trials. The major limitation of our study is the limited sample size and lack of power to detect a small effect.