The effect of comorbidity on the use of adjuvant chemotherapy and type of regimen for curatively resected stage III colon cancer patients

Abstract

Postsurgical chemotherapy is guideline‐recommended therapy for stage III colon cancer patients. Factors associated with patients not receiving adjuvant chemotherapy were identified in numerous studies; comorbidity was recognized as an important factor besides patient's age. We assessed the association between comorbidity and the use of adjuvant chemotherapy and type of chemotherapy regimen. Stage III colon cancer patients who underwent surgical resection were obtained from ten Centers for Disease Control and Prevention (CDC)‐NPCR Specialized Registries which participated in the Comparative Effectiveness Research (CER) project. Comorbidity was classified into no comorbidity recorded, Charlson, non‐Charlson comorbidities, number, and severity of Charlson comorbidity. Pearson chi‐square test and multivariable logistic regression were employed. Of 3180 resected stage III colon cancer patients, 64% received adjuvant chemotherapy. After adjusting for patient's demographic and tumor characteristics, there were no significant differences in receipt of chemotherapy between Charlson and non‐Charlson comorbidity. However, patients who had two or more Charlson comorbidities or had moderate to severe disease were significantly less likely to have chemotherapy (ORs 0.69 [95% CI, 0.51–0.92] and 0.62 [95% CI, 0.42–0.91], respectively) when compared with those with non‐Charlson comorbidity. In addition, those with moderate or severe comorbidities were more likely to receive single chemotherapy agent (P < 0.0001). Capecitabine and FOLFOX were the most common single‐ and multi‐agent regimens regardless of type of comorbidity grouping. Both the number and severity of comorbidity were significantly associated with receipt of guideline‐recommended chemotherapy and type of agent in stage III resected colon cancer patients. Better personalized care based on individual patient's condition ought to be recognized.

Impact of relative dose intensity of FOLFOX adjuvant chemotherapy on risk of death among stage III colon cancer patients

“…Second, there were substantial differences in the survival time or follow up time for different states, which resulted in a low percentage of events in the survival analysis and short-term survival outcome. Third, the data may underestimate the comorbid conditions, since patients with unknown comorbidity were categorized as no comorbidity according to the Facility Oncology Registry Data Standard (FORDS) coding manual [20,37]. In addition, data about comorbidity severity, postoperative complications and reasons for stopping chemotherapy were not available.…”

“…Covariates included age at colon cancer diagnosis (<50, 50-59, 60-69, and >70 years), race/ethnicity (Non-Hispanic white, Non-Hispanic black, Hispanics and others) [20], health insurance (private insurance including Medicare with private supplement, Medicare/other public, Medicaid, and not insured), censustract residence (100% urban, 100% rural, and urban/rural mixed), census-tract population below the federal poverty level (<20% and >20%), census-tract adults with less than high school education (<25% and >25%) [21,22], census-tract population percentage of married (<50% and >50%) [23], tumor size (< 4 cm and > 4 cm) [24,25], lymph nodes retrieved (<12 and >12) [26], tumor grade (well/moderately differentiated, and poor/undifferentiated), Charlson comorbidity index (0, >1) [27], anatomic subsites (proximal, distal, and others) [28], colon cancer classi cation (only with colon cancer, multiple cancers with colon as the rst primary cancer, multiple cancers with colon as the non-rst cancer) [29], number of positive lymph nodes (continuous variable), and delayed chemotherapy (receiving chemotherapy > 8 weeks after surgery: yes and no) [30].…”

Impact of adjuvant chemotherapy on the survival of patients with breast cancer diagnosed by screening

“…Moreover, the CCI is a reliable system for evaluating survival, and our study highlights its utility as an independent predictor of mortality in patients with breast cancer diagnosed by screening. 23,24 Despite these benefits, few previous studies have included this instrument in their evaluation of treatment strategies, and none have examined the influence of ACh in breast cancer tumors identified in national screening programs. One of the main strengths of our study, and hence of the conclusions drawn, is that the survival analysis was adjusted not only for the stage of the disease but also for comorbidity, as determined by the CCI.…”

Impact of relative dose intensity of FOLFOX adjuvant chemotherapy on risk of death among stage III colon cancer patients

“…Covariates included age at colon cancer diagnosis (< 50, 50-59, 60-69, and ≥ 70 years), race/ethnicity (Non-Hispanic white, Non-Hispanic black, Hispanics and others), 20 health insurance (private insurance including Medicare with private supplement, Medicare/other public, Medicaid, and not insured), census-tract residence (100% urban, 100% rural, and urban/rural mixed), census-tract population below the federal poverty level (< 20% and ≥ 20%), census-tract adults with less than high school education (< 25% and ≥ 25%). 21,22 census-tract population percentage of married (≤ 50% and > 50%), 23 tumor size (≤ 4 cm and > 4 cm), 24,25 lymph nodes retrieved (< 12 and ≥ 12), 26 tumor grade (well/moderately differentiated, and poor/undifferentiated), Charlson comorbidity index (0, ≥ 1), 27 anatomic subsites (proximal, distal, and others), 28 colon cancer classification (only with colon cancer, multiple cancers with colon as the first primary cancer, multiple cancers with colon as the non-first cancer), and number of positive lymph nodes (continuous variable).…”