Oxaliplatin/5-fluorouracil-based adjuvant chemotherapy as a standard of care for colon cancer in clinical practice: Outcomes of the ACCElox registry

2015 ◽  
Vol 11 (4) ◽  
pp. 334-342 ◽  
Author(s):  
Young Suk Park ◽  
Jiafu Ji ◽  
John Raymond Zalcberg ◽  
Mostafa El-Serafi ◽  
Antonio Buzaid ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Clinical Practice ◽  
Adjuvant Chemotherapy ◽  
Standard Of Care

scholarly journals Reasons for delay in timely administration of adjuvant chemotherapy for patients with stage III colon cancer: a multicentre cohort study from the McGill University Department of Oncology

2021 ◽  
Vol 10 (1) ◽  
pp. e000934
Author(s):  
Arielle Elkrief ◽  
Genevieve Redstone ◽  
Luca Petruccelli ◽  
Alla'a Ali ◽  
Doneal Thomas ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Clinical Practice ◽  
Adjuvant Chemotherapy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cox Regression ◽  
Health Centre ◽  
Stage Iii ◽  
Stage Iii Colon Cancer ◽  
Mcgill University

PurposeAdjuvant chemotherapy within 56 or 84 days following curative resection is globally accepted as the standard of care for stage III colon cancer as it has been associated with improved overall survival. Initiation of adjuvant chemotherapy within this time frame is therefore recommended by clinical practice guidelines, including the European Society for Medical Oncology. The objective of this study was to evaluate adherence to these clinical practice guidelines for patients with stage III colon cancer across the Rossy Cancer Network (RCN); a partnership of McGill University’s Faculty of Medicine, McGill University Health Centre, Jewish General Hospital and St Mary’s Hospital Center.Patients and methods187 patients who had been diagnosed with stage III colon cancer and received adjuvant chemotherapy within the RCN partner hospitals from 2012 to 2015 were included. Patient and treatment information was retrospectively determined by chart review. Χ2 and Wilcoxon rank-sum tests were used to measure associations and a multivariate Cox regression model was used to determine risk factors contributing to delays in administration of adjuvant chemotherapy.ResultsThe median turnaround time between surgery and adjuvant chemotherapy was 69 days. Importantly, only 27% of patients met the 56-day target, and 71% met the 84-day target. Increasing age, having more than one surgical complication and being diagnosed between 2013–2014 and 2014–2015 reduced the likelihood that patients met these targets. Furthermore, delays were observed at most intervals from surgery to first adjuvant chemotherapy treatment.ConclusionOur study found that within these academic hospital settings, 27% of patients met the 56-day target, and 71% met the 84-day target. Delays were associated with hospital, surgeon and patient-related factors. Initiatives in quality improvement are needed in order to improve adherence to recommended treatment guidelines for prompt administration of adjuvant chemotherapy for stage III colon cancer.

Uptake of adjuvant chemotherapy for colon cancer in older and younger patients in the Irish population.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 478-478
Author(s):  
Seamus Coyle ◽  
Zia Rehman ◽  
Chalen Lee ◽  
Sandra Deady ◽  
Harry Comber ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Clinical Practice ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Older Patients ◽  
The Elderly ◽  
Stage Ii ◽  
Stage Iii ◽  
Younger Patients ◽  
The Impact

478 Background: Colon cancer is predominantly a disease of the elderly, with recent evidence supporting the use of adjuvant chemotherapy in the older population. However, it remains unclear to what degree such patients are receiving adjuvant therapy in clinical practice. We examined uptake of adjuvantchemotherapy and it’s impact on survival in older patients with stage II and stage III colon cancer in a national cohort. Methods: Using the National cancer Registry of Ireland, we identified 3,486 patients with stage II and III colon cancer who were treated with curative resection from 2004-2009. Clinopathological features and chemotherapy use were compared between those ≥70 years and those < 70 years. Results: A total of 2,026 patients with stage II disease were identified, 56% male and 60% ≥ 70 years. T3 tumors accounted for 81%, T4 19% and 89% were grade 2/3. Adjuvant chemotherapy was utilized in 10% and 40% of ≥ 70 and <70 years, respectively (p<0.0001). A benefit for chemotherapy over observation alone was seen in both the older [HR 0.36; 95% CI 0.36 – 0.68; p <0.0001] and younger patient groups [HR 0.43; 95% CI 0.2701 - 0.6881; p<0.0004]. Of 1,460 patients with stage III disease, 51% were ≥ 70 years, 54% male. 34% of older and 83% of younger patients received adjuvant therapy (p<0.0001). A similar magnitude of benefit from chemotherapy compared to observation was seen in patients ≥ 70 years [HR 0.30; 95% CI 0.29 - 0.45 ; p <0.0001] and <70 years [HR 0.22 95%CI 0.1 – 0.2; p<0.0001] with stage III disease. Conclusions: Adoption of adjuvant chemotherapy appears to be associated with significant survival benefit in older patients (age ≥ 70 years), however, is still underutilized in clinical practice. The impact of sociodemographic and clinicopathological features as potential drivers of treatment decisions in a cohort of this population will be reported.

Translating IDEA to Practice and Beyond: Managing Stage II and III Colon Cancer

2019 ◽  
pp. 226-235 ◽  
Author(s):  
Sharlene Gill ◽  
Jeffrey A. Meyerhardt ◽  
Monica Arun ◽  
Christine M. Veenstra
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Early Stage ◽  
Standard Of Care ◽  
Stage Ii ◽  
Stage Iii Colon Cancer ◽  
Optimal Duration ◽  
Accepted Standard ◽  
Early Stage Colon Cancer ◽  
Resected Stage

Adjuvant fluoropyrimidine-based chemotherapy has been the standard of care for resected stage III colon cancer since the 1990s; the evolution from 12 to 6 months of fluoropyrimidine therapy and the addition of oxaliplatin to fluoropyrimidine therapy have led to the current accepted standard. However, controversies remain. What is the benefit of adjuvant chemotherapy in stage II disease, and in whom? What is the optimal duration of adjuvant chemotherapy? How should patients with early-stage colon cancer be followed after surgery and adjuvant treatment? Recent evidence has emerged to help inform these important questions, including the International Duration Evaluation of Adjuvant therapy (IDEA) collaboration, which is the largest, prospective study in colon cancer with 12,834 patients. This review discusses current and future risk stratification strategies in stage II disease: the optimal duration of adjuvant oxaliplatin-containing chemotherapy in stage II and III disease according to the IDEA study, and the recent evidence and updated recommendations for surveillance of early-stage colon cancer after resection.

Benefit of adjuvant chemotherapy in patients with T4, UICC II colon cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 700-700
Author(s):  
Andreas Teufel ◽  
Michael Gerken ◽  
Janine Hartl ◽  
Timo Itzel ◽  
Stefan Fichtner-Feigl ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Cox Regression ◽  
Standard Of Care ◽  
Population Based ◽  
Postoperative Chemotherapy ◽  
R0 Resection ◽  
Uicc Stage ◽  
Cox Regression Analysis ◽  
High Risk Situation

700 Background: Colorectal cancer is the third most common cancer and a major cause of morbidity and mortality worldwide. Adjuvant chemotherapy is considered standard of care in patients with UICC stage III colon cancer after R0-resection. For patients with UICC stage II colon cancer, a benefit of adjuvant therapy was not demonstrated. However, there is an ongoing discussion whether adjuvant chemotherapy may be beneficial for a subgroup of UICC II patients with "high-risk situation" (e.g., T4 situation). Methods: We investigated our Bavarian, population based (2.1 million inhabitants) cohort of 1,937 patients with UICC II CRC for a benefit of adjuvant chemotherapy in patients with larger (T4) tumors. Patients over 80 years were excluded. Of these patients, 240 patients had a T4 tumor (12%). 77 of all T4 patients received postoperative chemotherapy (33%). Survival analyses were performed using Kaplan Meier analysis and Cox regression models. Results: Patients with a T4 tumor who received postoperative chemotherapy had a highly significant survival benefit with respect to overall survival (p<0.001) and recurrence free survival (p=0.008). However, no difference was seen between oxaliplatin containing or non-oxaliplatin containing treatment regimens. Finally, G2 and G3 tumors were demonstrated to particularly benefit from adjuvant treatment. Chemotherapy, age at diagnosis and tumor grading remained independent risk factors in multivariable cox regression analysis. Conclusions: Overall, our retrospective study demonstrated a significant benefit of an adjuvant chemotherapy in the T4 UICC II subgroup of patients with colon cancer. Based on our data adjuvant chemotherapy should strongly be considered in these patients.

scholarly journals Clinical Practice in the Use of Adjuvant Chemotherapy for Patients with Colon Cancer in South Korea: a Multi-Center, Prospective, Observational Study

2016 ◽  
Vol 7 (2) ◽  
pp. 136-143
Author(s):  
Jung Han Kim ◽  
Moo Jun Baek ◽  
Byung-Kwon Ahn ◽  
Dae Dong Kim ◽  
Ik Yong Kim ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Clinical Practice ◽  
Adjuvant Chemotherapy ◽  
Observational Study ◽  
South Korea ◽  
Prospective Observational Study

Potential budget impact of capecitabine versus 5-FU/LV as adjuvant chemotherapy for stage III (SIII) colon cancer in Canada and its provinces

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6581-6581
Author(s):  
K. Virik ◽  
C. Skedgel ◽  
T. Younis
Keyword(s):  
Colon Cancer ◽  
Steady State ◽  
Adjuvant Chemotherapy ◽  
Impact Analysis ◽  
Budget Impact ◽  
Cost Effective ◽  
Standard Of Care ◽  
Sensitivity Analyses ◽  
Effectiveness Model ◽  
Start Up

6581 Background: Adjuvant chemotherapy for SIII colon cancer is an accepted standard of care. Oral Capecitabine (CAP) has been shown to be at least equivalent and possibly superior to 5FU/LV (Mayo regimen) with regards to a superior relapse free survival. This new option is associated with a higher drug cost but improved toxicity profile and appears to be cost-effective (CE). An economic analysis was undertaken to examine the potential budget impact for CAP in Canada and its provinces for 2007 onwards. Methods: A previously developed cost-effectiveness model was adapted to a prevalence perspective to project the net budgetary impact of CAP over a 5 year horizon. The projected population and incidence of colon cancer for each Canadian province from 2007–2016 was obtained and the proportion of patients with SIII colon cancer suitable for adjuvant chemotherapy was estimated from the literature. The average budget impact in the first 5 years (start up phase) and subsequent years (steady state) was assessed in Canadian $. Results: The projected average annual impact for Canada is 13.9 million (M) during the start up phase and $11.8 M during the steady state phase (NL $210K, PEI $63K, NS $424K, NB $282K, QC $2.92M, ON $4.66M, MB $464K, SK $336K, AB $993K and BC 1.45M). Budget impact is greater during the initial start-up phase (2007–11), as the steady state impact (2012–16) includes relapses avoided over a 5-year period. Sensitivity analyses for key parameters will be provided. Conclusions: The annual budget impact of CAP decreases over time and reaches a steady state after 5 years when the full impact of decreased recurrences is captured. As CAP appears to be CE, budget impact analysis has the potential to assist in the planning of healthcare funding resources regarding this treatment option. [Table: see text]

Reducing time to initiation of colon cancer adjuvant chemotherapy in a large community-based hospital.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 125-125
Author(s):  
Karen Bochert ◽  
Brian Rentschler ◽  
Chris Powers ◽  
Frederick Slezak ◽  
Sameer A. Mahesh
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Meta Analysis ◽  
Relative Survival ◽  
Office Visit ◽  
Standard Of Care ◽  
Pathology Report ◽  
Port Placement ◽  
Before And After ◽  
Stage Ii Colon Cancer

125 Background: Chemotherapy is standard of care after definitive surgery for stage III and certain subsets of stage II colon cancer (CC). A recent meta-analysis showed that for every 4 week delay in administering adjuvant chemotherapy relative survival decreases by 15%. At our institution, 24% of patients undergoing colon cancer surgery in 2010 subsequently received chemotherapy. On average, this process took 41 days from date of discharge to first chemotherapy (range 12-166 days). We sought to decrease this time to an average of 28 days. Methods: Previously, starting adjuvant chemotherapy was a step-wise process starting from the surgeon’s post operative visit to the medical oncologist’s office visit followed by port placement and finally, the commencement of chemotherapy. We instituted a program of concurrent scheduling of appointments by the colorectal cancer navigator (CRCN) upon availability of the pathology report. Primary end-point was time to start of chemotherapy from day of discharge (TTCD). Results: Twenty-three patients were eligible since inception of the program in September 2011. Of these, 5 declined entry and 2 were under the care of non-participating physicians, hence excluded from analysis. TTCD before and after implementation of the program are shown in the table. Two patients required financial assistance for capecitabine (C) that delayed TTCD to > 4 weeks. Results are shown after excluding those patients as well. Conclusions: Utilizing the CRCN to coordinate appointments for patients who required adjuvant chemotherapy significantly decreased the TTCD which might translate into better CC outcomes. [Table: see text]

scholarly journals Adjuvant Chemotherapy for Stage III Colon Cancer

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2679 ◽  
Author(s):  
Julien Taieb ◽  
Claire Gallois
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Treatment ◽  
Standard Of Care ◽  
Disease Recurrence ◽  
Stage Iii ◽  
Clinical Practices ◽  
Duration Of Treatment ◽  
Risk Of Recurrence ◽  
Stage Iii Colon Cancer

In patients with stage III colon cancer (CC), adjuvant chemotherapy with the combination of oxapliplatin to a fluoropyrimidine (FOLFOX or CAPOX) is a standard of care. The duration of treatment can be reduced from 6 months to 3 months, depending on the regimen, for patients at low risk of recurrence, without loss of effectiveness and allowing a significant reduction in the risk of cumulative sensitive neuropathy. However, our capacity to identify patients that do really need this doublet adjuvant treatment remains limited. In fact, only 30% at the most will actually benefit from this adjuvant treatment, 50% of them being already cured by the surgery and 20% of them experiencing disease recurrence despite the adjuvant treatment. Thus, it is necessary to be able to better predict individually for each patient the risk of recurrence and the need for adjuvant chemotherapy together with the need of new treatment approaches for specific subgroups. Many biomarkers have been described with their own prognostic weight, without leading to any change in clinical practices for now. In this review, we will first discuss the recommendations for adjuvant chemotherapy, and then the different biomarkers described and the future perspectives for the management of stage III CC.

scholarly journals Adherence to Clinical Practice Guidelines and Colorectal Cancer Survival: A Retrospective High-Resolution Population-Based Study in Spain

2020 ◽  
Vol 17 (18) ◽  
pp. 6697
Author(s):  
Francisco Carrasco-Peña ◽  
Eloisa Bayo-Lozano ◽  
Miguel Rodríguez-Barranco ◽  
Dafina Petrova ◽  
Rafael Marcos-Gragera ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Clinical Practice ◽  
Adjuvant Chemotherapy ◽  
High Resolution ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Population Based ◽  
Population Based Study ◽  
Stage Iii Colon Cancer

Colorectal cancer (CRC) is the third most common cancer worldwide. Population-based, high-resolution studies are essential for the continuous evaluation and updating of diagnosis and treatment standards. This study aimed to assess adherence to clinical practice guidelines and investigate its relationship with survival. We conducted a retrospective high-resolution population-based study of 1050 incident CRC cases from the cancer registries of Granada and Girona, with a 5-year follow-up. We recorded clinical, diagnostic, and treatment-related information and assessed adherence to nine quality indicators of the relevant CRC guidelines. Overall adherence (on at least 75% of the indicators) significantly reduced the excess risk of death (RER) = 0.35 [95% confidence interval (CI) 0.28–0.45]. Analysis of the separate indicators showed that patients for whom complementary imaging tests were requested had better survival, RER = 0.58 [95% CI 0.46–0.73], as did patients with stage III colon cancer who underwent adjuvant chemotherapy, RER = 0.33, [95% CI 0.16–0.70]. Adherence to clinical practice guidelines can reduce the excess risk of dying from CRC by 65% [95% CI 55–72%]. Ordering complementary imagining tests that improve staging and treatment choice for all CRC patients and adjuvant chemotherapy for stage III colon cancer patients could be especially important. In contrast, controlled delays in starting some treatments appear not to decrease survival.

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