Abstract
BackgroundFactors that are prognostic of early discontinuation of adjuvant chemotherapy among stage III colon cancer patients have yet to be described. To address this gap, a survey of medical oncologists and a systematic review and meta‐analysis were conducted.MethodsA survey was distributed in March 2019 to medical oncologists who treat colon cancer within Alberta, Canada. Clinicians were asked to rank the prognostic importance of a set of variables using a Likert scale and agreement was quantified using a weighted Cohen's kappa. In addition, we systematically searched four databases up to July 2019. Meta‐analyses were conducted using a random‐effects model.ResultsOf the 25 clinicians who were sent the survey, 14 responded. Overall, there was no agreement regarding which variables were prognostic of early discontinuation (weighted Cohen's kappa = 0.12; 95% CI = 0.05‐0.18). From an initial 3927 articles, 18 investigations were identified for inclusion in our review. Based upon evidence from both the survey and the systematic review, the following four variables were identified as being prognostic of early discontinuation: (a) comorbidity (OR2+ vs 0 = 1.53; 95% CI = 1.30‐1.79); (b) performance status (ORECOG 2+ vs 0‐1 = 1.33; 95%CI = 1.07‐1.65); (c) T stage (ORT4 vs T1‐2 = 1.57; 95% CI = 0.99‐2.50); and (d) chemotherapy regimen (estimates not pooled due to heterogeneity). In addition to these factors, there was some suggestion that age, marital status/social support, muscle mass, N stage, and tumor grade had prognostic value.ConclusionsCurrent evidence is heterogeneous and limited. Additional research is needed to confirm our findings and to explore additional prognostic factors.
Highlights
Among individuals diagnosed with stage III colon cancer, treatment with adjuvant chemotherapy has been shown to increase six-year survival from approximately 50% to 73%.1,2 Despite such benefits, there are side-effects to adjuvant chemotherapy which have been well-documented in this patient population
The specific objectives of this investigation were to: (a) survey a group of medical oncologists and describe their perceptions regarding the prognostic importance of variables with respect to chemotherapy discontinuation; (b) determine if there was any agreement between clinicians regarding objective one; (c) systematically review the evidence to date and quantify the association between various patient, tumor, treatment, and provider characteristics and chemotherapy discontinuation; and (d) estimate the proportion of patients with stage III colon cancer who discontinue adjuvant chemotherapy
A cross-sectional survey was conducted to assess the opinions of practicing medical oncologists within Alberta, Canada regarding the prognostic importance of variables of early chemotherapy discontinuation
Summary
Among individuals diagnosed with stage III colon cancer, treatment with adjuvant chemotherapy has been shown to increase six-year survival from approximately 50% to 73%.1,2 Despite such benefits, there are side-effects to adjuvant chemotherapy which have been well-documented in this patient population. The purpose of this study was to provide evidence that would support: (a) the development of clinical tools used to predict the risk of discontinuation at the patient-level by helping to narrow a list of candidate variables and; (b) the estimation of the effect of chemotherapy duration on patient outcomes within observational settings by helping to identify a list of potential baseline confounders that should be considered in the analyses By examining both sources of evidence, we hoped to increase our certainty regarding variable importance and better identify areas for future research. The specific objectives of this investigation were to: (a) survey a group of medical oncologists and describe their perceptions regarding the prognostic importance of variables with respect to chemotherapy discontinuation; (b) determine if there was any agreement between clinicians regarding objective one; (c) systematically review the evidence to date and quantify the association between various patient, tumor, treatment, and provider characteristics and chemotherapy discontinuation; and (d) estimate the proportion of patients with stage III colon cancer who discontinue adjuvant chemotherapy
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