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Patterns of Referral for Adjuvant Chemotherapy for Stage II and III Colon Cancer: A Population-Based Study

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Reasons for variable utilization of adjuvant chemotherapy (ACT) for colon cancer have not been well described. We report medical oncology (MO) referral patterns and subsequent use of ACT.

Methods

Treatment records were linked to the population-based Ontario Cancer Registry to describe MO referral and ACT use among 5289 patients with stage II–III colon cancer treated in 2002–2008. Modified Poisson regression was used to analyze factors associated with MO referral and ACT use. Multilevel modeling was used to explore the proportion of variation in practice attributable to providers.

Results

There was wide geographic variation in MO referral rates for stage II (range 37–80 %, p < 0.001) and stage III disease (range 77–98 %, p < 0.001). Use of ACT among referred patients varied across regions for stage II (range 12–49 %, p < 0.001) but not stage III (range 67–79 %, p = 0.353). For both stages, younger patients (p < 0.001) with less comorbidity (p < 0.010) were more likely to be referred to MO and treated with ACT. Applying the fitted regression model to nonreferred stage III patients suggests that 38 % had >50 % probability of having ACT if they had seen a MO. Among stage III patients, 15 % percent of the variance in MO referral rate and 6 % of the variance in ACT utilization rate is attributable to the surgeon and MO respectively.

Conclusions

A substantial proportion of non-referred patients with stage III colon cancer may have been offered ACT if they had seen MO. A small proportion of variance in referral rate and ACT treatment is attributable to providers.

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Acknowledgement

This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Dr. Booth had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Booth is supported as a Canada Research Chair in Population Cancer Care. This work was supported by the Canada Foundation for Innovation and the Canadian Institutes of Health Research.

Disclosure

The authors report no conflicts of interest.

Disclaimer

Parts of this material are based on data and information provided by Cancer Care Ontario. However, the analysis, conclusions, opinions and statements expressed herein are those of the authors and not necessarily those of Cancer Care Ontario.

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Authors and Affiliations

  1. Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, Canada

    Gursimran Chandhoke MD, Xuejiao Wei MSc, William J. Mackillop MBChB & Christopher M. Booth MD

  2. Department of Oncology, Queen’s University, Kingston, Canada

    Sulaiman Nanji MD, PhD, James Biagi MD, William J. Mackillop MBChB & Christopher M. Booth MD

  3. Department of Public Health Sciences, Queen’s University, Kingston, Canada

    Yingwei Peng PhD, William J. Mackillop MBChB & Christopher M. Booth MD

  4. Department of Surgery, Queen’s University, Kingston, Canada

    Sulaiman Nanji MD, PhD

  5. Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada

    Monika Krzyzanowska MD

Authors
  1. Gursimran Chandhoke MD
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  2. Xuejiao Wei MSc
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  3. Sulaiman Nanji MD, PhD
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  4. James Biagi MD
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  5. Yingwei Peng PhD
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  6. Monika Krzyzanowska MD
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  7. William J. Mackillop MBChB
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  8. Christopher M. Booth MD
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Corresponding author

Correspondence to Christopher M. Booth MD.

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Chandhoke, G., Wei, X., Nanji, S. et al. Patterns of Referral for Adjuvant Chemotherapy for Stage II and III Colon Cancer: A Population-Based Study. Ann Surg Oncol 23, 2529–2538 (2016). https://doi.org/10.1245/s10434-016-5181-8

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  • DOI: https://doi.org/10.1245/s10434-016-5181-8

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