Opportunity lost: Adjuvant chemotherapy in patients with stage III colon cancer remains underused

Becerra, Adan Z.; Probst, Christian; Tejani, Mohamedtaki Abdulaziz; Aquina, Christopher T.; González, Maynor G.; Hensley, Bradley J.; Noyes, Katia; Monson, J. R. T.; Fleming, Fergal J.

doi:10.1016/j.surg.2015.03.057

Cited by 33 publications

(29 citation statements)

References 32 publications

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“…Several studies have shown treatment discordance of 10% to 20% associated with factors such as increased age, co-morbidity, and patient refusal. 14,15,26,27 Capturing this information in clinical cancer registries would provide important insight into possible explanations around receipt of adjuvant care.…”

Section: Rectal Cancer Treatment Stages B and Cmentioning

confidence: 99%

Use of guideline‐recommended adjuvant therapies and survival outcomes for people with colorectal cancer at tertiary referral hospitals in South Australia

Adelson

Fusco

Karapetis

et al. 2017

Evaluation Clinical Practice

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Section: Rectal Cancer Treatment Stages B and Cmentioning

confidence: 99%

Use of guideline‐recommended adjuvant therapies and survival outcomes for people with colorectal cancer at tertiary referral hospitals in South Australia

Adelson

Fusco

Karapetis

et al. 2017

Evaluation Clinical Practice

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“…Previous studies have reported that the rate of administration of ACT is related to the location and type of hospital , and therefore differs between hospitals. Schrag et al .…”

Section: Introductionmentioning

confidence: 99%

“…As a consequence of these findings, the guidelines of the American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO) recommend that ACT be considered for patients with high-risk Stages II and III CRC [6,9,10]. Despite these recommendations, some studies have found that not all patients in Western countries receive ACT for Stages II and III CRC [11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have reported that the rate of administration of ACT is related to the location and type of hospital [14,15], and therefore differs between hospitals. Schrag et al reported that the rate of ACT was higher in high-volume than low-volume hospitals, although Alter et al reported that low-volume hospitals had higher rates of ACT than high-volume hospitals [11,18].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic impact of interhospital variation in adjuvant chemotherapy for patients with Stage II/III colorectal cancer: a nationwide study

et al. 2018

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“…For patients with stage III colon cancer, the National Comprehensive Cancer Network (NCCN) guidelines recommends surgical resection and adjuvant chemotherapy (ACT) [ 1 ]. A robust body of evidence indicates that using ACT decreases the risk of recurrence and improves survival among stage III colon cancer patients [ 2 – 10 ]. It has also been demonstrated that including oxaliplatin in the drug combination has significantly improved the disease-free survival and overall survival, particularly in patients <70 years old [ 3 , 11 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Use of adjuvant chemotherapy in patients with stage III colon cancer in Puerto Rico: A population-based study

et al. 2018

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ObjectiveThis study aims to examine factors associated with the use of adjuvant chemotherapy and the use of oxaliplatin after curative resection in stage III colon cancer patients and assesses the effect of their use in three-year survival.MethodsThis retrospective cohort study was conducted using Puerto Rico Central Cancer Registry-Health Insurance Linkage Database. The study cohort consisted of stage III colon cancer patients with a curative surgery in the period 2008–2012. Multivariate logistic regression was used to estimate adjusted odds ratios. Kaplan-Meier methods and Cox proportional hazards models were used to assess the association between adjuvant chemotherapy and oxaliplatin use and overall survival and risk of death, respectively.ResultsOverall, 75% of the study population received adjuvant chemotherapy during the study period. Factors statistically associated with receiving adjuvant chemotherapy within four months after resection included being married (adjusted odds ratio [AOR] 1.64; 95% CI 1.18–2.28; p = 0.003), and being enrolled in Medicare (AOR 1.68; 95% CI: 1.03–2.75; p = 0.039) or Medicaid and Medicare dual eligible (AOR 1.66; 95% CI: 1.06–2.60; p = 0.028). However, patients aged ≥70 years were less likely to receive adjuvant chemotherapy (AOR 0.22; 95%CI 0.14–0.36; p<0.001).DiscussionWe observed a significant reduction in mortality in adjuvant chemotherapy treated patients. Similarly, patients <70 years treated with oxaliplatin had significantly lower risk of death than those who did not, although for patients ≥70 years no statistical significance was achieved. Future studies should assess effective interventions to reduce barriers to access guideline-based recommended colon cancer treatment.

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Opportunity lost: Adjuvant chemotherapy in patients with stage III colon cancer remains underused

Cited by 33 publications

References 32 publications

Use of guideline‐recommended adjuvant therapies and survival outcomes for people with colorectal cancer at tertiary referral hospitals in South Australia

Use of guideline‐recommended adjuvant therapies and survival outcomes for people with colorectal cancer at tertiary referral hospitals in South Australia

Prognostic impact of interhospital variation in adjuvant chemotherapy for patients with Stage II/III colorectal cancer: a nationwide study

Use of adjuvant chemotherapy in patients with stage III colon cancer in Puerto Rico: A population-based study

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