Determinants of Variation in the Use of Adjuvant Chemotherapy for Stage III Colon Cancer in England

Abstract

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%

Mortality due to cancer treatment delay: systematic review and meta-analysis

“… 62 Innovations in surgical technique could also minimise morbidity and reduce time to adjuvant therapy. 63 64 …”

“…Satellite centres might improve capacity for treating patients, as can reconfiguration of existing infrastructure to high volume super specialised services, or single entry models and team based care 62. Innovations in surgical technique could also minimise morbidity and reduce time to adjuvant therapy 6364…”

Determinants of variation in radical local treatment for men with high-risk localised or locally advanced prostate cancer in England

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The association of comorbidities with administration of adjuvant chemotherapy in stage III colon cancer patients: a systematic review and meta-analysis

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“…4,5 Despite the benefits of chemotherapy for stage III colon cancer, between one-third and nearly half of the patients still do not receive this effective treatment. 6,7 Older age is the main determinant of chemotherapy non-use, 6,8,9 but about one-fifth of patients younger than 75 years do not receive chemotherapy, 9,10 suggesting that there might be other relevant factors that affect treatment administration aside from age. Colon cancer is mainly diagnosed at older age, when comorbidities (e.g.…”