Variations in the Type of Adjuvant Chemotherapy Among Stage III Colon Cancer Patients in England

Abstract

Purpose: Treatment with any adjuvant chemotherapy for Stage III colon cancer has been shown to differ between groups. Few studies, however, explore variations in the type of adjuvant chemotherapy received, none of which from the UK. The aim of this study is to explore variation in the type of chemotherapy received by Stage III colon cancer patients. Methods: Data from the national cancer registry was linked to the Systemic Anti-Cancer Therapy database, which provides detailed information on treatment of malignant diseases from all NHS England chemotherapy providers. Demographic and clinical characteristics were compared between those who received monotherapy ( uoropyrimidine) or combination chemotherapy ( uoropyrimidine and oxaliplatin) among Stage III colon cancer patients.Results: Of 8,750 patients who received adjuvant chemotherapy, 22.3% (n=2,359) received monotherapy and 60.4% (n=6,391) received combination therapy. The odds of receiving combination therapy decreased with age. Those from the most deprived group had half the odds (OR: 0.5, CI: 0.42,0.59, p<0.001) of receiving combination therapy compared to the least deprived group. Women were 14% less likely to get combined therapy (OR: 0.86, CI: 0.77,0.95, p=0.005). Those with the largest tumour size (T4) and those with more than 3 lymph nodes involved (N2) had 30% (OR: 1.30; CI: 1.07,1.59; p=0.008) and 50% (OR: 1.50; 1.34,1.69; p<0.001) higher odds of receiving combination therapy compared to T1 or T2 and N1, respectively. Conclusion: There is variation in the type of chemotherapy received for stage III colon cancer patients by sociodemographic factors, despite clear clinical guidelines.

Where are the inequalities in colorectal cancer care in a country with universal healthcare? A systematic review and narrative synthesis

“…Five of the six studies evaluating the use of adjuvant chemotherapy demonstrated inequalities 24 44 45 50 51. Meanwhile, both studies evaluating the use of palliative chemotherapy demonstrated similar inequalities 24 46.…”

“…The system interval was examined in 12 studies, with 7 different time points evaluated, summarised in figure 2 12–23. In total, 15 studies reported the receipt of surgery,19 20 24–36 7 studies evaluated surgical variation,37–43 14 studies reported the receipt of chemotherapy,19 20 24–27 44–51 7 reported the receipt of radiotherapy19 20 25–27 43 52 and 2 reported the receipt of any treatment 17 46…”

“…In total, 32 of the 41 studies adjusted or stratified for at least one other factor 12–26 32–41 44–49 51. The remaining nine studies provided unadjusted rates 27–31 42 43 50 52…”

“…In total, 13 studies examined whether patients received any chemotherapy,19 20 24–27 44–50 11 of which conducted adjusted analyses 19 20 24–26 44–49. Six studies evaluated the use of adjuvant chemotherapy 24 44 45 49–51. Two studies evaluated the use of palliative chemotherapy 24 46.…”

“…One study examined the receipt of combination versus single-agent chemotherapy, adjusting for age, sex, ethnicity, tumour size, lymph node yield and year of diagnosis 51. However, no adjustment was made for comorbidity.…”