Differences In Adjuvant Chemotherapy Research Articles

Differences in adjuvant chemotherapy and oncological outcomes according to margin status in patients with stage III colon cancer

Background Microscopically positive margins to lymph node metastases (R1LNM) are associated with poorer oncological outcomes in patients with Stage 3 colon cancer. These poorer outcomes were seen despite a greater proportion of these patients receiving adjuvant chemotherapy when compared to those with microscopically negative (R0) margins. We sought to determine if differences in the type or duration of adjuvant chemotherapy could account for the differences in outcomes seen between patients with R0 and R1LNM margins. Methods A multicentre retrospective study including patients undergoing surgery for Stage 3 colon cancer between 2016–2019 at specialist centres. Patients were stratified according to margins status (R0 vs R1LNM). Type/duration of chemotherapy and oncological outcomes were compared between groups. Results 718 patients were included, of whom 100 had R1LNM margins (13.1%). Patients with R1LNM margins had significantly poorer 3-year distant metastases-free (R0 78.2% (95% CI 74.5–81.3) versus R1LNM 58.8% (95% CI 47.2–68.6), p < 0.001) and disease specific survival (R0 88.3% (95% CI 85.2–90.9) versus R1LNM 78.5% (95% CI 68.0–85.8), p < 0.001) when compared to those with R0 margins. No differences were noted in the proportion of patients who completed long-course chemotherapy or were treated with oxaliplatin-based combinations between the R1LNM and R0 groups. Differences in outcomes between R0 and R1LNM groups persisted even when only those patients who completed long-course chemotherapy were compared. Discussion Differences in adjuvant chemotherapy do not appear to account for the poorer oncological outcomes seen in patients with R1LNM margins after surgery for Stage 3 colon cancer. This suggests that adjuvant chemotherapy may be less effective in this patient group. Further studies to elucidate a potential biological basis for this difference are warranted.

Ethnic differences in colon cancer care in the Netherlands: a nationwide registry-based study

BackgroundEthnic differences in colon cancer (CC) care were shown in the United States, but results are not directly applicable to European countries due to fundamental healthcare system differences. This is the first study addressing ethnic differences in treatment and survival for CC in the Netherlands.MethodsData of 101,882 patients diagnosed with CC in 1996–2011 were selected from the Netherlands Cancer Registry and linked to databases from Statistics Netherlands. Ethnic differences in lymph node (LN) evaluation, anastomotic leakage and adjuvant chemotherapy were analysed using stepwise logistic regression models. Stepwise Cox regression was used to examine the influence of ethnic differences in adjuvant chemotherapy on 5-year all-cause and colorectal cancer-specific survival.ResultsAdequate LN evaluation was significantly more likely for patients from ‘other Western’ countries than for the Dutch (OR 1.09; 95% CI 1.01–1.16). ‘Other Western’ patients had a significantly higher risk of anastomotic leakage after resection (OR 1.24; 95% CI 1.05–1.47). Patients of Moroccan origin were significantly less likely to receive adjuvant chemotherapy (OR 0.27; 95% CI 0.13–0.59). Ethnic differences were not fully explained by differences in socioeconomic and hospital-related characteristics. The higher 5-year all-cause mortality of Moroccan patients (HR 1.64; 95% CI 1.03–2.61) was statistically explained by differences in adjuvant chemotherapy receipt.ConclusionThese results suggest the presence of ethnic inequalities in CC care in the Netherlands. We recommend further analysis of the role of comorbidity, communication in patient-provider interaction and patients’ health literacy when looking at ethnic differences in treatment for CC.

Comparison of adjuvant chemotherapy use in African American women with breast cancer versus the rest of the adjuvant breast cancer population

6069 Background: Demographics, specifically race have been discussed as reasons for disparity of care in the breast cancer setting. Methods: We used a validated database with physician entered, de-identified patient data from a randomized sample of oncologists in the US. Physicians capture de-identified data on up to 20 patients per week using a clinically validated, software driven algorithm. We evaluated all female patient records with breast cancer that were receiving adjuvant chemotherapy for their disease, from January 2005 through November 2005. All data elements are required fields, allowing for a complete patient record with each entry, including race, age, stage, nodal status, hormone status, her 2 status and chemotherapy treatments. Results: During this 11 month period, 4465 adjuvant breast cancer records were received. All were included in this analysis. Of the 4465 patient records, 69%( n=3085) were Caucasian, 18% (n= 830) were African American, 9% (n=408) were Hispanic/Latino and 4% were ‘other, which included, Native American and Asian patients. The average age for Caucasian patients was 56 years; average age for African American patients was 55 years, average age for Hispanic/Latino patients 51 years, average for all other patients 55 years. 63% of the Caucasian patients had node + disease, 59% of African Americans had node + disease, 62% of Hispanic/Latinos had node + disease, and 61% of all others had node + disease. Top treatment regimens for Caucasian patients were AC followed by Taxol (dose dense), AC, AC followed by Taxotere (dose dense), ACT (Taxotere) and CMF. Top treatment regimens for African Americans were AC followed by Taxol (dose dense), AC, AC followed by Taxotere (dose dense), ACT (Taxotere) and FAC. Conclusions: In this clinically similar patient population there was no difference in adjuvant chemotherapy selected based upon race. Further evaluations of treatment selections, including, surgery, radiation and endocrine therapy by race are warranted. No significant financial relationships to disclose.