OBJECTIVE: To ascertain whether the National Quality Forum-endorsed time interval for adjuvant chemotherapy (AC) initiation optimizes patient outcome. BACKGROUND: Delayed AC initiation for stage III colon cancer is associated with worse survival and the focus of a National Quality Forum quality metric (<4 months among patients aged <80 years). METHODS: Observational cohort study of patients with stage III colon cancer younger than 80 years within the National Cancer Data Base (2003-2010). The primary outcome was 5-year overall survival evaluated using multivariate Cox proportional hazards regression. Aggregate survival estimates for historical surgery-only controls from pooled National Surgical Adjuvant Breast and Bowel Project trial data were also used. RESULTS: Among 51,331 patients (60.8 ± 11.6 years, 50.2% males, and 77.3% white), 76.3% received standard AC (≤ 2 months) and 21.6% delayed (>2 and <4 months) AC. Earlier AC was associated with better 5-year overall survival [standard AC, 69.8%; delayed AC, 62.0%; late AC (4-6 months), 51.4%; log-rank, P < 0.001]. The survival rate after late AC was similar to surgery alone (51.1%; Wilcoxon rank sum, P = 0.10). Compared with late AC, standard AC (hazard ratio, 0.62; 95% confidence interval, 0.54-0.72) and delayed AC (hazard ratio, 0.77; 95% confidence interval, 0.66-0.89) significantly decreased risk of death. Risk of death was also lower for standard AC compared to delayed AC (hazard ratio, 0.81; 95% confidence interval, 0.77-0.86). CONCLUSIONS: One in 5 patients with stage III colon cancer initiates AC within the National Quality Forum-endorsed interval, but does not derive the full benefit. These data support strengthening current quality improvement initiatives and colon cancer treatment guidelines to encourage AC initiation within 2 months of resection when possible, but not beyond 4 months.
OBJECTIVE: To ascertain whether the National Quality Forum-endorsed time interval for adjuvant chemotherapy (AC) initiation optimizes patient outcome. BACKGROUND: Delayed AC initiation for stage III colon cancer is associated with worse survival and the focus of a National Quality Forum quality metric (<4 months among patients aged <80 years). METHODS: Observational cohort study of patients with stage III colon cancer younger than 80 years within the National Cancer Data Base (2003-2010). The primary outcome was 5-year overall survival evaluated using multivariate Cox proportional hazards regression. Aggregate survival estimates for historical surgery-only controls from pooled National Surgical Adjuvant Breast and Bowel Project trial data were also used. RESULTS: Among 51,331 patients (60.8 ± 11.6 years, 50.2% males, and 77.3% white), 76.3% received standard AC (≤ 2 months) and 21.6% delayed (>2 and <4 months) AC. Earlier AC was associated with better 5-year overall survival [standard AC, 69.8%; delayed AC, 62.0%; late AC (4-6 months), 51.4%; log-rank, P < 0.001]. The survival rate after late AC was similar to surgery alone (51.1%; Wilcoxon rank sum, P = 0.10). Compared with late AC, standard AC (hazard ratio, 0.62; 95% confidence interval, 0.54-0.72) and delayed AC (hazard ratio, 0.77; 95% confidence interval, 0.66-0.89) significantly decreased risk of death. Risk of death was also lower for standard AC compared to delayed AC (hazard ratio, 0.81; 95% confidence interval, 0.77-0.86). CONCLUSIONS: One in 5 patients with stage III colon cancer initiates AC within the National Quality Forum-endorsed interval, but does not derive the full benefit. These data support strengthening current quality improvement initiatives and colon cancer treatment guidelines to encourage AC initiation within 2 months of resection when possible, but not beyond 4 months.
Authors: Robert J Panzer; Richard S Gitomer; William H Greene; Patricia Reagan Webster; Kevin R Landry; Charles A Riccobono Journal: JAMA Date: 2013-11-13 Impact factor: 56.272
Authors: James J Biagi; Michael J Raphael; William J Mackillop; Weidong Kong; Will D King; Christopher M Booth Journal: JAMA Date: 2011-06-08 Impact factor: 56.272
Authors: Neal W Wilkinson; Greg Yothers; Samia Lopa; Joseph P Costantino; Nicholas J Petrelli; Norman Wolmark Journal: Ann Surg Oncol Date: 2010-04 Impact factor: 5.344
Authors: L G M van der Geest; J E A Portielje; M W J M Wouters; N I Weijl; B C Tanis; R A E M Tollenaar; H Struikmans; J W R Nortier Journal: Colorectal Dis Date: 2013 Impact factor: 3.788
Authors: C G Moertel; T R Fleming; J S Macdonald; D G Haller; J A Laurie; P J Goodman; J S Ungerleider; W A Emerson; D C Tormey; J H Glick Journal: N Engl J Med Date: 1990-02-08 Impact factor: 91.245
Authors: Ryan P Merkow; David J Bentrem; Mary F Mulcahy; Jeanette W Chung; Daniel E Abbott; Thomas E Kmiecik; Andrew K Stewart; David P Winchester; Clifford Y Ko; Karl Y Bilimoria Journal: Ann Surg Date: 2013-12 Impact factor: 12.969
Authors: Mark A Healy; Arden M Morris; Paul Abrahamse; Kevin C Ward; Ikuko Kato; Christine M Veenstra Journal: BMC Cancer Date: 2018-04-27 Impact factor: 4.430
Authors: Timothy P Hanna; Will D King; Stephane Thibodeau; Matthew Jalink; Gregory A Paulin; Elizabeth Harvey-Jones; Dylan E O'Sullivan; Christopher M Booth; Richard Sullivan; Ajay Aggarwal Journal: BMJ Date: 2020-11-04