Time to adjuvant chemotherapy (AC) in stage III colon cancer at a community cancer center: A quality improvement initiative.

Abstract

e17503 Background: The standard of care for stage III colon cancer remains 5FU based AC. In clinical trial settings, this begins within 56 days of surgery. Recently a meta-analysis suggested that delays to starting chemotherapy are associated with inferior outcomes and the goal should be to commence AC as soon as feasible. Our objective was to assess the time to starting AC for referred patients to our center and to identify modifiable factors which may be improve upon to reduce delays. Methods: All patients referred to our center with stage III colon cancer who received at least 1 cycle of intravenous AC between Jan.1, 2010 and Dec.31, 2010 were identified. Patient characteristics and time intervals between surgery, Medical Oncology referral, Medical Oncology consultation and initiation of AC were assessed. Results: The total number of patients is 43. Median time to initiation of AC from surgery was 60 days with a range of 29-118 days. Only 32% of patients commenced AC within 56 days of surgery. The intervals of time from surgery to Medical Oncology referral and Medical Oncology consultation to initiation of AC were similar with a median of 25 and 26 days respectively. The median time interval from Medical Oncology referral to Medical Oncology consultation was only 9 days. The bulk of the interval for initiation of AC after seeing a Medical Oncologist was for placement of central intravenous (CIV) devices which took a median of 19 days. Conclusions: The majority of our patients do not start AC within an accepted timeframe. Most of the delay is related to the interval taken to request a consultation to Medical Oncology by the surgeon and to Medical Oncology access to CIV devices. Educational programs geared to referring surgeons which stress the importance of timely AC can help and are being initiated. Further options such as pre booking CIV devices and colon cancer patient-specific nurse navigators to try and streamline the processes and reduce their delays are being explored. [Table: see text]