Time from surgery to first adjuvant chemotherapy: Experiences at two Toronto hospitals.

Abstract

e17557 Background: Optimal treatment of patients with colorectal cancer (CRC) includes the timely administration of adjuvant chemotherapy (AC). While Cancer Care Ontario (CCO) guidelines advise that CRC patients receive their first AC no later than 8 weeks after surgical resection, new data suggests treatment should begin between 4 and 6 weeks. This retrospective study was performed to determine the treatment times and identify barriers at two Toronto hospitals: St. Michael’s Hospital (SMH) and Mount Sinai Hospital (MSH). Methods: Of all 797 patients diagnosed with CRC between January 1, 2005 and April 30, 2012 at SMH and MSH, 483 patients did not meet eligibility criteria. Thus, our sample population of 314 patients had stage II or III CRC, and received both surgical resection and AC at each respective hospital. Data collected included: time from surgery to first AC, patient demographics, and systemic/clinical barriers. Data was analyzed using statistical methods in Excel, assuming p-values <0.05 as significant. Results: The mean ageof the patients was 60.5 years (range 23 – 91); 55% were male and 72% had stage III disease; 75% (237/314) had colon cancer and 75% of AC was the FOLFOX regimen. The mean time from surgery to first AC was 57.4 days (sd = 16.8) or 8.2 weeks (range 4.1-18.7). Referral from surgeon averaged 20 days (sd=29.3). Time from medical oncology consult to first AC averaged 26.5 days (sd=30.8) including 23 days awaiting port-a-cath insertion. Post-operative medical complications affected 23.6% of patients. The presence of a complication was associated with delay in AC (10.6 days, p<0.001). An association between tumour site (eg. colon vs. locally advanced rectal cancer) and delay (p=0.0002) was also observed. Conclusions: Adherence to CCO guidelines can be optimized in CRC patients at SMH and MSH. The presence of a medical complication and tumour site are both factors associated with delays in AC treatment post-surgery. To improve the timeliness of care and achieve greater consistency between hospitals, rapid-cycle improvement of confounding barriers will be adopted.