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