Abstract
Background
Adjuvant chemotherapy for stage III colon cancer is underutilized in the United States.
The aim of this study was to assess the use of adjuvant chemotherapy in younger and
medically fit patients and analyze the socioeconomic factors associated with its utilization.
Methods
Using the National Cancer Database from 2004 to 2015, we selected stage III colon
cancer patients between age 18 to 65, Charlson-Deyo Comorbidity Index (CDCI) of 0
or 1, and those that survived at least 12 months after surgery. We then compared patients
that underwent surgery only with those that received adjuvant chemotherapy. Multivariable
logistic regression analysis was performed to identify variables associated with adjuvant
chemotherapy use in the population. Overall survival was estimated by Kaplan-Meier
curves.
Results
Of the 48,336 patients that met inclusion criteria, 43,315 (90%) received adjuvant
chemotherapy. The utilization of adjuvant chemotherapy increased from 87% in 2004
to 91% in 2015. On multivariable regression analysis, the use of adjuvant chemotherapy
was lower among males, Non-Hispanic Blacks and Hispanics, low-grade cancer, left-sided
tumors, CDCI 1, those who travel ≥ 50 miles, yearly income < $40,227, and uninsured
patients. The most common reason for the omission of adjuvant chemotherapy was the
patient or caregiver's choice (40% between 2013 and 2015). The 5-year and 10-year
overall survival rates were 76.7% and 63.8% respectively, in those who received adjuvant
chemotherapy as compared to 65.1% and 49.3% in those who underwent surgery only (P < .001).
Conclusion
In young and medically fit stage III colon cancer patients, most patients received
guideline-compliant care in the United States. However, socioeconomic disparities
adversely impacted the use of adjuvant chemotherapy. The patient or caregiver's decision
was the most common reason for non-adherence to adjuvant chemotherapy and lead to
poor survival outcomes. Emphasis should be placed on developing patient-centered strategies
to improve adherence to chemotherapy in all patients.
Keywords
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Reference
- Cancer statistics, 2022.CA Cancer J Clin. 2022; 72: 7-33https://doi.org/10.3322/caac.21708
- Colorectal cancer statistics, 2020.CA: A Cancer J Clin. 2020; 70: 145-164https://doi.org/10.3322/caac.21601
- Adjuvant therapy for patients with colon and rectal cancer.Jama. 1990; 264: 1444-1450
- NCCN guidelines insights: colon cancer, version 2.2018.J Natl Compr Canc Netw. 2018; 16: 359-369https://doi.org/10.6004/jnccn.2018.0021
- Rates and predictors of chemotherapy use for stage III colon cancer: a systematic review.Cancer. 2008; 113: 3279-3289https://doi.org/10.1002/cncr.23958
- Adjuvant chemotherapy for stage III colon cancerimplications of race/ethnicity, age, and differentiation.JAMA. 2005; 294: 2703-2711https://doi.org/10.1001/jama.294.21.2703
- Opportunity lost: Adjuvant chemotherapy in patients with stage III colon cancer remains underused.Surgery. 2015; 158: 692-699https://doi.org/10.1016/j.surg.2015.03.057
- Racial/ethnic disparities in colorectal cancer treatment utilization and phase-specific costs, 2000-2014.PLoS One. 2020; 15e0231599https://doi.org/10.1371/journal.pone.0231599
- Patient age and comorbidity are major determinants of adjuvant chemotherapy use for stage III colon cancer in routine clinical practice.J Clin Oncol. 2008; 26 (author reply 4517-8): 4516-4517https://doi.org/10.1200/jco.2008.18.7443
- Adjuvant chemotherapy use and adverse events among older patients with stage III colon cancer.JAMA. 2010; 303: 1037-1045https://doi.org/10.1001/jama.2010.272
- Concordance with NCCN colorectal cancer guidelines and ASCO/NCCN quality measures: an NCCN institutional analysis.J Natl Compr Canc Netw. 2009; 7: 895-904https://doi.org/10.6004/jnccn.2009.0059
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.J Clin Epidemiol. 1992; 45: 613-619https://doi.org/10.1016/0895-4356(92)90133-8
- Daily practice in guideline adherence to adjuvant chemotherapy in stage III colon cancer and predictors of outcome.Eur J Surg Oncol. 2021; 47: 2060-2068https://doi.org/10.1016/j.ejso.2021.03.236
- Chemotherapy use in stage III colon cancer: a national cancer database analysis.Ther Adv Med Oncol. 2015; 7: 244-251https://doi.org/10.1177/1758834015587867
- Impact of age on the use of adjuvant treatments in patients undergoing surgery for colorectal cancer: patients with stage III colon or stage II/III rectal cancer.BMC Cancer. 2019; 19: 735https://doi.org/10.1186/s12885-019-5910-z
- Age, sex, and racial differences in the use of standard adjuvant therapy for colorectal cancer.J Clin Oncol. 2002; 20: 1192-1202https://doi.org/10.1200/jco.2002.20.5.1192
- Multidisciplinary teams in the management of rectal cancer.Clin Colon Rectal Surg. 2007; 20: 143-147https://doi.org/10.1055/s-2007-984858
- The multidisciplinary team meeting improves staging accuracy and treatment selection for gastro-esophageal cancer.Dis Esophagus. 2006; 19: 496-503https://doi.org/10.1111/j.1442-2050.2006.00629.x
- Decreasing use of chemotherapy in older patients with stage III colon cancer irrespective of comorbidities.J Natl Compr Canc Netw. 2019; 17: 1089-1099https://doi.org/10.6004/jnccn.2019.7287
- Chemotherapy treatment decision-making experiences of older adults with cancer, their family members, oncologists and family physicians: a mixed methods study.Support Care Cancer. 2017; 25: 879-886https://doi.org/10.1007/s00520-016-3476-8
- A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients.N Engl J Med. 2001; 345: 1091-1097https://doi.org/10.1056/NEJMoa010957
- Duration of adjuvant chemotherapy for stage III colon cancer.Eng J Med. 2018; 378: 1177-1188https://doi.org/10.1056/NEJMoa1713709
- ctDNA applications and integration in colorectal cancer: an NCI colon and rectal-anal task forces whitepaper.Nat Rev Clin Oncol. 2020; 17: 757-770https://doi.org/10.1038/s41571-020-0392-0
- AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study.BMC Cancer. 2019; 19: 1247https://doi.org/10.1186/s12885-019-6478-3
- Age and adjuvant chemotherapy use after surgery for stage III colon cancer.J Natl Cancer Inst. 2001; 93: 850-857https://doi.org/10.1093/jnci/93.11.850
Article info
Publication history
Published online: September 16, 2022
Accepted:
September 14,
2022
Received:
July 29,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
