Introduction
There is strong evidence supporting the efficacy of adjuvant chemotherapy for patients
with pathologic, stage III colon cancer. This study examines differences in adherence
to evidence-based adjuvant chemotherapy guidelines for pathologic, stage III colon
cancer cases across hospital and patient subgroups.
Methods
Patients with stage III colon cancer were identified from the 2003 to 2011 National
Cancer Data Base (NCDB). A logistic regression model was used to estimate the odds
of receipt of adjuvant chemotherapy across varying hospital and patient characteristics.
A multivariable Cox proportional hazards model was used to estimate the association
between receipt of adjuvant chemotherapy and 5-year survival. Risk adjusted observed/expected
(O/E) outcome ratios were calculated for each hospital to compare hospital-specific
quality of care during the study period.
Results
A total of 124,008 patients met the inclusion criteria. Adjuvant chemotherapy was
not administered to 34%. The rates of adjuvant chemotherapy have shown little improvement
over time (63% in 2003 vs 66% in 2011). The Cox model indicates that patients receiving
adjuvant chemotherapy had better survival (hazard ratio = 0.48, 95% confidence interval
0.47–0.49). Analysis of risk adjusted O/E ratios indicated no consistent pattern as
to which hospitals were performing optimally or subopitmally over time.
Conclusion
There has been no meaningful improvement in receipt of chemotherapy in patients with
stage III colon cancer. The fact that chemotherapy is not being considered or offered
to more than 20% of patients with node-positive colon cancer suggests that there are
substantial process failures across many institutions and regions in the United States.
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Article info
Publication history
Published online: May 29, 2015
Accepted:
March 17,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
