Referral patterns and adjuvant chemotherapy use in patients with stage II colon cancer

Abstract

17515 Background: Little is known about the rate of use of adjuvant chemotherapy in stage II colon cancer and about referral patterns that give patients access to this treatment. We studied patients from a tertiary referral center with stage II colon cancer to determine the factors associated with referral to medical oncology and adjuvant chemotherapy administration. Methods: We searched the tumor registry at Baylor University Medical Center Dallas to identify patients with stage II colon cancer who underwent resection between 1995- 2003. Pathologic stage was confirmed and referral information and patient characteristics were recorded from individual chart review. The rates of referral to medical oncology and adjuvant chemotherapy use were calculated and potential predictive variables including age, sex, insurance status, bowel obstruction at diagnosis, co-morbidity score, tumor grade and T stage were analyzed using univariate and multivariate techniques. Results: We identified 287 patients with stage II colon cancer, of which only one hundred and sixty patients (56%) were referred to a medical oncologist. Only poorly differentiated histology was a significant predictor of referral using multivariate analysis. Using univariate analysis, age younger than 50, private insurance status and poorly differentiated histology were significant predictors of referral. Eighty patients (28%) received adjuvant chemotherapy. Age younger than 50, private insurance status, lower co-morbidity score, higher T stage, and poor tumor differentiation were significant predictors of adjuvant chemotherapy use in univariate and multivariate analysis. Conclusions: During 1995–2003 just over half of patients at this large tertiary referral center with resected stage II colon cancer were referred to medical oncology, potentially limiting patient discussion and access to the full spectrum of cancer care options. Adjuvant chemotherapy was used frequently for the patients who were referred to medical oncology. In addition to accepted high-risk features such as T stage and tumor grade, patient age and co-morbidity score were significant predictors for the use of adjuvant treatment. No significant financial relationships to disclose.