Hospital Variability in Use of Adjuvant Chemotherapy for Patients with Stage 2 and 3 Colon Cancer. Issue 12 (December 2016)

• Record Type: Journal Article
• Authors: Daly, Meghan C.; Hanseman, Dennis J.; Abbott, Daniel E.; Shah, Shimul A.; Paquette, Ian M.
• Is Part Of: Diseases of the colon & rectum. Volume 59:Issue 12(2016:Dec.)
• Publication Date: 2016-12
• Subjects: Adjuvant -- Chemotherapy -- Colon cancer -- Hospital type -- Hospital volume; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; Colonic Diseases -- Periodicals; Colorectal Surgery -- Periodicals; 616.34
• DOI: 10.1097/DCR.0000000000000704
• Languages: English
• ISSNs: 0012-3706

Abstract

Abstract : BACKGROUND: Following oncologic resection, adjuvant chemotherapy is associated with decreased recurrence and improved survival in stage 3 colon cancer. However, there is controversy regarding its use in stage 2 colon cancer with high-risk features (tumor depth T4, poorly differentiated, positive margin, and/or inadequate lymph node retrieval). Consensus guidelines recommend no adjuvant chemotherapy in the absence of these high-risk features (low-risk stage 2). OBJECTIVE: This study aimed to examine hospital characteristics associated with poor risk-adjusted, stage-specific guideline compliance for the use of adjuvant chemotherapy in stage 3 and low-risk stage 2 colon cancer. DESIGN: This was a retrospective study. Stepwise logistic regression was used to identify patient and hospital factors associated with administration of adjuvant chemotherapy. Hierarchical regression models were used to calculate risk- and reliability-adjusted rates of chemotherapy use and observed-to-expected ratios in each hospital's stage 2 low-risk and stage 3 patients. SETTINGS: Data were retrieved from the National Cancer Database. PATIENTS: Patients selected were adults treated with oncologic resection for stage 2 to 3 colon cancer between 2004 and 2010. MAIN OUTCOME MEASURES: The primary outcome measured was receipt of adjuvant chemotherapy. RESULTS: A total of 167, 345 patients were identified at 1395 hospitals. The mean overall risk-adjusted adjuvant chemotherapy rate was 65.3% for stage 3 and 15.2% for low-risk stage 2. Analysis of low outlier hospitals for stage 3 colon cancer, where adjuvant chemotherapy was underutilized, demonstrated that 62.8% were low-volume centers and 51.4% were community centers. Of high outlier hospitals for stage 2 low-risk disease, where adjuvant chemotherapy was overutilized, 87.2% were low-volume hospitals and 67.2% were community centers. LIMITATIONS: Selection bias and the inability to compare specific chemotherapy regimens were limitations of this study. CONCLUSIONS: Following oncologic resection, administration of adjuvant chemotherapy for low-risk stage 2 and stage 3 disease varies substantially among hospitals in the United States. Outlier hospitals were most likely to be low-volume community centers.