Colorectal cancer adjuvant chemotherapy trends among a nonelderly veteran cohort at a southern veterans health administration

Background For patients with high‐risk stage II or stage III colorectal cancer (CRC), adjuvant chemotherapy (AC) improves survival, yet use varies substantially across medical oncology settings. Aim Utilization of guideline concordant CRC AC was assessed at a Veterans Health Administration (VHA) fac...

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Bibliographic Details
Published in:Cancer reports 2022-07, Vol.5 (7), p.e1508-n/a
Main Authors: Martin, Richard L., Edwards, Gretchen C., Samuels, Lauren R., Eng, Cathy, Roumie, Christianne L.
Format: Article
Language:English
Subjects:
Adjuvants
cancer care
Cancer therapies
Cardiovascular disease
Chemotherapy
clinical guidelines
Colorectal cancer
Colorectal surgery
Diabetes
Gastroenterology
Kidney diseases
Length of stay
Lymphatic system
Metastasis
Morbidity
Oncology
Original
Pathology
pathway analysis
Patients
R&D
Research & development
Trends
Vein & artery diseases
Veterans
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Summary:Background For patients with high‐risk stage II or stage III colorectal cancer (CRC), adjuvant chemotherapy (AC) improves survival, yet use varies substantially across medical oncology settings. Aim Utilization of guideline concordant CRC AC was assessed at a Veterans Health Administration (VHA) facility to determine quality improvement initiatives. Methods and Results The study was a retrospective review of CRC surgeries from January 1, 2000 to December 31, 2015 at a South Regional VHA. Inclusion criteria consisted of pathologic high‐risk stage II or stage III CRC, with exclusion for age ≥80, age ≥75 hospitalized with major co‐morbidity in the prior year, and death or discharge to hospice within 30 days of the index surgery. The primary predictor was year‐group; partitioned 2000–2005, 2006–2010, 2011–2015 to account for changes in NCCN high risk stage II definitions. Primary outcome was AC receipt. Secondary outcome was reason for chemotherapy omission. Among 180 eligible surgeries (121 colon and 59 rectal cancers), patients were mostly male (96%), white (79%) and with median age 64 years. Overall, 117 (65%) received AC. Compared to 2000–2005, patients undergoing surgery between 2011 and 2015 were less likely to receive AC (odds ratio 0.35; 95% confidence interval [CI] 0.14–0.82), due to more patients declining AC (27% vs. 6%, p 
ISSN:2573-8348
2573-8348
DOI:10.1002/cnr2.1508