Better Late Than Never?: Adherence to Adjuvant Therapy Guidelines for Stage III Colon Cancer in An Underserved Region

ObjectiveIn 2008, the American College of Surgeons Commission on Cancer (CoC) issued a quality guideline for Stage III colon cancer (CC) recommending adjuvant chemotherapy (AC) within 120 days of diagnosis. We examined... [ view full abstract ]

Objective

In 2008, the American College of Surgeons Commission on Cancer (CoC) issued a quality guideline for Stage III colon cancer (CC) recommending adjuvant chemotherapy (AC) within 120 days of diagnosis. We examined adherence in a healthcare system serving a region with disparities in CC outcomes.

Methods

In a retrospective analysis of patients (2005-2014) with Stage III CC in a multi-hospital healthcare system, the associations between adherence, clinicopathologic, demographic, geographic and socioeconomic data and overall survival (OS) were examined.

Results

Of 1171 CC patients, 438 (37.4%) had Stage III disease with 63% (n=276) receiving AC and 37% (n=162) not. AC conferred a five-year OS advantage (62.4% vs. 42.5%, p<0.0001). Younger age independently predicted AC receipt (OR=0.95, p<0.0001).  Of 252 AC patients <80y, 75.8% were CoC guideline-compliant (GC) whereas 24.2% were not (nGC).  Although there was no OS difference between GC and nGC, both had superior survival (p<0.0001) compared to non-AC patients. Surgical complications trended towards independent association with non-compliance (p=0.07)

Conclusion

Guideline compliance in our system (63%) is lower than the CoC Estimated Performance Rate (72.4%).  Age influenced absolute receipt of AC while surgical complications may impact guideline compliance. Even when administered beyond 120 days, AC was associated with a survival benefit.