Adjuvant chemotherapy (ACT) for stage III colon cancer is well-established. This study aimed to explore determinants of ACT use and between-hospital variation within the English National Health Service. 11,932 patients (diagnosed 2014-2017) with pathological stage III colon cancer in the English NHS were identified from the National Bowel Cancer Audit. Records were linked to Systemic Anti-Cancer Therapy and Hospital Episode Statistics databases.Multi-level logistic regression analyses were performed to estimate independent factors for ACT use including age, sex, deprivation, comorbidities, performance status, ASA, surgical urgency, surgical access, TNM staging, re-admission and hospital-level factors (University teaching hospital, on-site chemotherapy and high-volume centre). A random intercept was modelled for each English NHS hospital (n=142).Between-hospital variation was explored using funnel plot methodology. Fullyadjusted random-intercept models were fitted separately in young (<70 years) and elderly (≥70 years) patients, and intra-class correlation coefficients estimated. 60.7% of patients received ACT. Age was the strongest determinant. Compared to patients <60 years, those aged 60-64 (adjusted odds ratio (aOR) 0.76 (95%
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