A statewide evaluation of adjuvant chemotherapy for stage III colon cancer.

Abstract

e14034 Background: Because of patient (pt) refusal or co-morbidity conditions, the optimal percentage of individuals receiving adjuvant chemotherapy has not been described in literature. This was evaluated in Delaware. Methods: A retrospective review of patient records of those not receiving adjuvant chemotherapy for stage III colon cancer (CC). The Delaware Cancer Registry (DCR) contained 296 stage III CC cases diagnosed from 2003-06 with receipt of adjuvant chemotherapy, treatment data or receipt of chemotherapy unknown. For the treatment unknown group, the DCR queried the submitting hospital to verify whether any additional treatment data was available in the hospital cancer registry. A refined list of 91 pts with no record of chemotherapy became the study group. A three-physician team assembled to review the records at the hospital that provided the treatment. An epidemiologist from the Delaware Division of Public Health oversaw study protocol, accompanied the physician team during reviews, and provided the necessary forms to standardize the data collection. Results: 91/296 (30.7%) patients with stage III CC were documented not to receive chemotherapy. 45 (49%) males , 46 (51%) females. 73 patients (80%) Caucasian, 17 (19%) African-American, one individual (1%) listed “Other Race”. 32/ 91 pts who did not receive chemotherapy (35%) were age 85 or older; another 38 (42%) between the ages of 75 and 84, and the remaining 23% were 74 years of age and under. All 45 patients between the ages of 30 and 54 received chemotherapy. The documented reasons for lack of chemotherapy, with patient frequencies: (a) pt co-morbidities (N=45; 49.5%); (b) pt expired postoperative (60 days) period (N=16; 17.6%); (c) pt refusal (N=13; 14.3%); (c) age (N=8; 8.8%); (d) pt lost to follow-up (N=2; 2.2%); and (f) unknown reasons (N=7; 7.7%). Conclusions: In Delaware, 70% of pts received systemic chemotherapy .90% of untreated pts had valid reasons not to receive chemotherapy. Medical co-morbidity, pt refusal and early death accounted for 82% of the absence of chemotherapy and were associated with advancing pt age. This statewide analysis suggests that a maximum population based adjuvant chemotherapy utilization rate of 70% exists for stage III colon cancer.