Factors associated with delayed time to adjuvant chemotherapy (AC) in stage III colon cancer: British Columbia Cancer Agency (BCCA) cohort experience.

Abstract

e16603 Background: The current standard for stage III colon cancer after resection is adjuvant 5FU-based chemotherapy. In trials, AC is mandated within 8 weeks after surgery, but this is not always the case outside the clinical trial setting. A recent meta-analysis confirms that AC started more than 8 weeks after curative surgery results in significantly decreased overall survival. Our objective was to ascertain logistical and patient factors associated with delayed delivery of AC (defined as >56 days from date of surgery) in referred patients with resected stage III colon cancer. Methods: A population-based cohort of patients diagnosed with stage 3 colon cancer between January 2008 to December 2009 referred to the BCCA and treated with at least one cycle of AC were identified. Patient characteristics, and event-specific time intervals between surgery, referral, medical oncology consultation (MOC) and AC were assessed. Differences in patient characteristics and event intervals between patients who received delayed and timely chemotherapy were assessed using the Chi-square and Wilcoxon Rank-sum tests. Results: Median time from surgery to AC was 58 days with 54% of patients receiving AC beyond 56 days. Temporal differences were identified in all event intervals between the between the timely and delayed groups (see table). Referral was most commonly initiated after hospital discharge The only patient factors associated with delayed initiation included poorer ECOG status and being treated at the most urban centre within BCCA. Age, gender, comorbidity index, T stage and tumour location were not different between the groups. Conclusions: 54% of patients with stage III colon cancer had delayed AC initiation. Process related delays at each step of the referral process need to be addressed including timely referral, MOC triage and addressing chemotherapy waitlists. Time to chemotherapy Event interval Statistic All cases ≤56 days >56 days P value Surgery to referral (days) N 370 164 206 Median 15 12 18 p<0.0001 Referral to med onc N 349 156 193 consult (days) Median 21 17 23 p<0.0001 Med onc consult to N 395 182 213 chemotherapy (days) Median 20 14 26 p<0.0001