Integrated post-surgical colon cancer care planning at the Rutgers Cancer Institute of New Jersey and Robert Wood Johnson University Hospital.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 75-75
Author(s):  
Teresa V. Brown ◽  
Kristen Donohue ◽  
Sondra Patella ◽  
Viktor Y. Dombrovskiy ◽  
Rebecca Anne Moss ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Medical Oncology ◽  
University Hospital ◽  
Pathology Report ◽  
Care Planning ◽  
Time To Initiation ◽  
Central Access ◽  
Chemotherapy Initiation ◽  
Colon Cancer Care

75 Background: Colorectal cancer is the second leading cause of cancer death in the United States each year. The use of adjuvant chemotherapy after surgical resection of colon cancer has been associated with a survival benefit. Timely initiation of adjuvant chemotherapy has been shown to have an effect on overall and disease-free survival. There is no integrated post-surgical colon cancer care planning for patients who have surgery at our institution. Poor understanding on the part of patients and ancillary providers regarding appropriate follow up may cause delay in time to adjuvant chemotherapy initiation. Methods: Baseline data was obtained for the ASCO Quality Training Program. Chart review was conducted on patients with stage III colorectal cancer that were treated at the Cancer Institute of New Jersey and Robert Wood Johnson University Hospital to identify average time to adjuvant chemotherapy initiation and factors which were thought to have a strong influence on chemotherapy initiation. Time to initiation of adjuvant chemotherapy, pathology report resulting, central access obtainment, and outpatient medical oncology appointment was abstracted from patient charts. Other factors including the presence of intraoperative or postoperative complications, type of surgeon, academic versus private medical oncologist, and the presence of an inpatient medical oncology consult were also identified and reviewed. Results: 128 patient charts were reviewed. Mean number of days from surgery to adjuvant chemotherapy (n = 79) was 49.6, to pathology report resulting (n = 70) was 4.92, to central access obtainment (n = 49) was 40, and to outpatient medical oncology appointment (n = 38) was 30. The presence of intraoperative (p < 0.059) and postoperative complications (p < 0.0155) was found to have a statistically significant effect on time to initiation of adjuvant chemotherapy. Conclusions: While there are some uncontrollable factors like operative complications that delay time to initiation of chemotherapy, engaging the patient may help decrease the time to adjuvant chemotherapy by increasing patient awareness of the importance of seeking aggressive postoperative care.

Racial/ethnic differences in use of surgery and adjuvant chemotherapy for nonmetastatic colon cancer: Where's the rub?

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 529-529
Author(s):  
J. Yang ◽  
P. Mauldin ◽  
M. Ebeling ◽  
T. Hulsey ◽  
M. B. Thomas ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Medical Oncology ◽  
Stage I ◽  
Stage Iii ◽  
Independent Effect ◽  
Chi Square ◽  
Black Race ◽  
Hispanic Ethnicity

529 Background: Disparities in receipt of recommended medical therapy for colon cancer have been reported. The objective of this study was to determine the independent effect of black race and Hispanic ethnicity on use of surgery/adjuvant therapy in patients (pts) with nonmetastatic colon cancer, controlling for surgical/medical oncology consultation Methods: Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified 26,946 pts aged 66 and older with resected stage I-III colon cancer diagnosed between 1999-2004. Surgical/medical oncology consultation and receipt of chemotherapy were ascertained from Medicare claims. The relationships between patient/tumor characteristics, surgical/medical oncology consultation, and use of surgery/adjuvant therapy were analyzed using chi square tests. Odds ratios (OR) of receipt of surgery/chemotherapy were calculated using logistic regression analysis. Results: We identified 23,834 white, 2,022 black, and 1,090 Hispanic pts with stage I (7,088 pts), stage II (9,510 pts), and stage III (7,236 pts) colon cancer. Blacks and Hispanics were more likely to be younger, less educated, of lower income, and have greater comorbidity compared to whites. Rates of surgical resection were lower among blacks than Hispanics (86.6% vs. 88.8% vs. 92.0% in whites, all p < 0.001). Blacks with stage III colon cancer (but not Hispanics) were also less likely to receive adjuvant chemotherapy (48.2% vs. 54.7% in whites, p < 0.001). After controlling for socioeconomic status, comorbidity, and surgical/medical oncology consultation, black race (but not Hispanic ethnicity) was independently associated with underuse of surgery (adjusted OR, 0.68; 95% confidence interval [CI], 0.51-0.89) and adjuvant chemotherapy (adjusted OR, 0.71; 95% CI, 0.60-0.85). Conclusions: Black race, but not Hispanic ethnicity, is a powerful, independent predictor of underuse of surgery and adjuvant chemotherapy in pts with nonmetastatic colon cancer. Qualitative studies are needed to determine whether patient misperceptions about colon cancer surgery/chemotherapy or suboptimal physician-patient interactions may underlie these observations. No significant financial relationships to disclose.

Reasons for delay in time to initiation of adjuvant chemotherapy (AC) for colon cancer (CC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14553-e14553
Author(s):  
David Warren Wasserman ◽  
Majdi Boulos ◽  
Christopher M. Booth ◽  
Wilma Hopman ◽  
Rachel Anne Goodwin ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Medical Records ◽  
Medical Oncology ◽  
Venous Catheter ◽  
Multivariate Logistic Regression Model ◽  
Intercurrent Illness ◽  
Time To Initiation ◽  
Operative Complications ◽  
Meta Analyses ◽  
Post Operative Complications

e14553 Background: AC improves survival among patients with colon cancer. Two meta-analyses have demonstrated a decrease in survival with increasing time to AC (TTAC). Here, we examine the predominant factors leading to delay in TTAC. Methods: Individual medical records of 565 patients with CC who initiated AC Aug 2005-Nov 2010 in Eastern Ontario were reviewed to capture patient and treatment characteristics including: medical comorbidities, post-operative complications, the reason if AC was not ordered after initial medical oncology (MO) consultation, dates of surgery, referral to MO, MO consult, central venous catheter (CVC) insertion, and first cycle of AC. Patients were then categorized into two groups: (i) medical/surgical reason for delay (MSRD), defined as post-operative complications or intercurrent illness, and (ii) No MSRD. No MSRD patients were further subcategorized as post-MO delay (PMOD), defined as AC deferred at time of consultation due to patient preference or further investigations required, vs. No PMOD. A multivariate logistic regression model was used to determine factors associated with TTAC > 8 weeks (w). Results: In the No MSRD group (n= 423), 25% (n=107) were subdivided into the PMOD subgroup. On multivariate analysis, TTAC >8w was significantly associated with the presence of a MSRD [OR = 2.4 (1.6-3.9), p = <0.001] or PMOD [OR = 3.3 (1.9-5.6), p = <0.001]. No other significant associations were found, including oral vs. IV AC. Proportion of cases with TTAC >8w in the subgroups were: MSRD 76.1% (n = 108); PMOD 80.4% (n = 86); No PMOD 57.6% (n = 182). Conclusions: MSRD and PMOD are strong predictors of increased TTAC; however, the majority of patients have no MSRD or PMOD. TTAC in this group is 9 weeks. This suggests that TTAC is modifiable, and likely reflects delays in referral, consultation, and chemotherapy booking. [Table: see text]

Reasons for delay in time to initiation of adjuvant chemotherapy (TTAC) for colon cancer (CC): Analysis from six academic centers in Ontario, Canada.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. 6541-6541
Author(s):  
Ketan Ghate ◽  
Ronald L. Burkes ◽  
Christine B. Brezden ◽  
Kevin M. Zbuk ◽  
Brandon Matthew Meyers ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Time To Initiation

scholarly journals Adjuvant Chemotherapy in Resected Lung Cancer: Two-Year Experience in a University Hospital

2008 ◽  
Vol 15 (5) ◽  
pp. 270-274 ◽  
Author(s):  
Nicole Bouchard ◽  
Francis Laberge ◽  
Bruno Raby ◽  
Sylvie Martin ◽  
Yves Lacasse
Keyword(s):  
Lung Cancer ◽  
Clinical Practice ◽  
Adjuvant Chemotherapy ◽  
Surgical Resection ◽  
Randomized Trials ◽  
Medical Oncology ◽  
Early Stage ◽  
University Hospital ◽  
Quebec City ◽  
Significant Difference

BACKGROUND: Randomized trials have confirmed the benefits of adjuvant chemotherapy in improving survival in resected early-stage non-small-cell lung cancer (NSCLC). The extent to which these results have translated into clinical practice is unknown.OBJECTIVE: To examine the referral pattern of patients with resected lung cancer to adjuvant chemotherapy, and to compare compliance and toxicities with current literature.METHODS: A retrospective analysis of all patients who underwent a surgical resection for lung cancer at Laval Hospital (Quebec City, Quebec) from March 2004 to January 2006 was conducted.RESULTS: A total of 258 patients underwent surgery. Seven patients were excluded because of early postoperative death, and two patients were excluded because of incomplete data. Data from 249 patients were analyzed (94% NSCLC). Fifty per cent were referred to medical oncology for consideration of adjuvant chemotherapy, including 37 of 61 patients with stage II NSCLC. One hundred patients received chemotherapy. No significant difference in age, sex, comorbidities and surgical procedures was observed between those who received chemotherapy and those who did not. Chemotherapy was initiated 47 days (median) after the surgery and consisted mainly of cisplatin-vinorelbine (38%), cisplatin-etoposide (22%) and carboplatin-paclitaxel (20%). Sixty-six per cent of the patients completed all four cycles. Grade 3 or 4 toxicities consisted mainly of fatigue (23%) and cytopenia (40%). No death was registered; 15% had to be hospitalized because of adverse effects.CONCLUSION: Although adjuvant chemotherapy is gaining acceptance in clinical practice, more patients should be referred to medical oncology following surgical resection. Compliance and toxicity are similar to or better than those described in published randomized trials.

scholarly journals Reasons for Delay in Time to Initiation of Adjuvant Chemotherapy for Colon Cancer: a Multi-Institution Study

2014 ◽  
Vol 25 ◽  
pp. iv198
Author(s):  
J. Biagi ◽  
R. Burkes ◽  
C. Brezden-Masley ◽  
K. Zbuk ◽  
B. Meyers ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Time To Initiation

scholarly journals Evaluation of A 55-Gene Classifier As A Prognostic Biomarker for Adjuvant Chemotherapy in Stage III Colon Cancer Patients

2021 ◽  
Author(s):  
Eiji Oki ◽  
Eiji Shinto ◽  
Mototsugu Shimokawa ◽  
Shigeki Yamaguchi ◽  
Megumi Ishiguro ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Statistical Significance ◽  
Predictive Biomarkers ◽  
Recurrence Risk ◽  
University Hospital ◽  
Stage Iii ◽  
Clinical Trial Registry ◽  
Stage Iii Colon Cancer ◽  
Education Network

Abstract Background Adjuvant chemotherapy reduces the recurrence risk in stage III colon cancer (CC). However, better prognostic and predictive biomarkers are required to stratify patients for treatment. We constructed a 55-gene classifier (55GC) and investigated its utility for classifying patients with stage III CC. Methods We retrospectively identified patients with stage III CC aged 20–79 years who received adjuvant chemotherapy with or without oxaliplatin during 2009–2012. Results Among 938 eligible patients, 203 and 201 patients who received adjuvant chemotherapy with and without oxaliplatin, respectively, were selected by propensity-score matching. Of these, 95 patients from each group were analyzed and their 5-year relapse-free survival (RFS) rates with and without oxaliplatin were 73.7% and 77.1%, respectively. The hazard ratios for 5-year RFS for adjuvant chemotherapy (fluoropyrimidine), with or without oxaliplatin, were 1.241 (95% CI, 0.465–3.308; P = 0.67) and 0.791 (95% CI, 0.329–1.901; P = 0.60), respectively. Stratification using the 55GC revealed that 52 (27.3%), 78 (41.1%), and 60 (31.6%) patients had microsatellite instability (MSI)-like, chromosomal instability (CIN)-like, and stromal subtypes, respectively. The 5-year RFS rates were 84.3% and 72.0% in patients treated with and without oxaliplatin, respectively, for the MSI-like subtype (HR, 0.495; 95% CI, 0.145–1.692; P = 0.25). No RFS rate differences were noted in CIN-like or stromal subtypes. Stratification by cancer sidedness for each subtype showed improved RFS only in left-sided primary cancer treated with oxaliplatin for the MSI-like subtype (P = 0.007). The 5-year RFS rates for the MSI-like subtype in left-sided cancer were 100% and 53.9% with and without oxaliplatin, respectively. Conclusions Subclassification using 55GC and tumor sidedness revealed increased RFS of patients within the MSI-like subtype with stage III left-sided CC treated with fluoropyrimidine with oxaliplatin relative to those treated without oxaliplatin. However, the predictive power of 55GC subtyping alone did not reach statistical significance in this cohort, warranting larger prospective studies. Trial registration: The study protocol was registered in the University Hospital Medical Education Network (UMIN) clinical trial registry (UMIN study ID 000023879).

Reducing time to initiation of colon cancer adjuvant chemotherapy in a large community-based hospital.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 125-125
Author(s):  
Karen Bochert ◽  
Brian Rentschler ◽  
Chris Powers ◽  
Frederick Slezak ◽  
Sameer A. Mahesh
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Meta Analysis ◽  
Relative Survival ◽  
Office Visit ◽  
Standard Of Care ◽  
Pathology Report ◽  
Port Placement ◽  
Before And After ◽  
Stage Ii Colon Cancer

125 Background: Chemotherapy is standard of care after definitive surgery for stage III and certain subsets of stage II colon cancer (CC). A recent meta-analysis showed that for every 4 week delay in administering adjuvant chemotherapy relative survival decreases by 15%. At our institution, 24% of patients undergoing colon cancer surgery in 2010 subsequently received chemotherapy. On average, this process took 41 days from date of discharge to first chemotherapy (range 12-166 days). We sought to decrease this time to an average of 28 days. Methods: Previously, starting adjuvant chemotherapy was a step-wise process starting from the surgeon’s post operative visit to the medical oncologist’s office visit followed by port placement and finally, the commencement of chemotherapy. We instituted a program of concurrent scheduling of appointments by the colorectal cancer navigator (CRCN) upon availability of the pathology report. Primary end-point was time to start of chemotherapy from day of discharge (TTCD). Results: Twenty-three patients were eligible since inception of the program in September 2011. Of these, 5 declined entry and 2 were under the care of non-participating physicians, hence excluded from analysis. TTCD before and after implementation of the program are shown in the table. Two patients required financial assistance for capecitabine (C) that delayed TTCD to > 4 weeks. Results are shown after excluding those patients as well. Conclusions: Utilizing the CRCN to coordinate appointments for patients who required adjuvant chemotherapy significantly decreased the TTCD which might translate into better CC outcomes. [Table: see text]

Reasons for delay in time to initiation of adjuvant chemotherapy for colon cancer: A multi-institution study.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e14504-e14504
Author(s):  
James Joseph Biagi ◽  
Ronald L. Burkes ◽  
Christine B. Brezden ◽  
Kevin M. Zbuk ◽  
Brandon Matthew Meyers ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Time To Initiation
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