A population-based study of adjuvant chemotherapy for stage-II and -III colon cancers
ABSTRACT Although clinical trials have demonstrated that adjuvant chemotherapy improves survival for stage-III colon cancer, the benefits remain controversial for stage-II lesions. The objective of the present study was to determine the extent to which adjuvant chemotherapy is used for patients with stage-II and -III colon cancers.
The study population comprised 1074 patients with stage-II and -III colon cancers diagnosed in 2000 in 12 French administrative districts and recorded in population-based cancer registries. Data were collected using a standardized procedure.
Overall, 20.4% of patients with stage II and 61.9% with stage III received adjuvant chemotherapy. Age at diagnosis was the strongest determinant of chemotherapy. Among stage-II patients, those receiving chemotherapy decreased from 57.6% in patients aged <or=50 years to 1.1% in those aged >or=85. The corresponding percentages with stage III were 93.6% and 1.4%. In multivariate analyses, other factors found to be independently and significantly associated with administration of adjuvant chemotherapy for stage II were extension of the cancer (stage IIA vs. stage IIB), clinical presentation (obstruction or perforation vs. uncomplicated cancer) and discussion of the case at a multidisciplinary case-review meeting. For stage III, apart from age, discussion of the case at a multidisciplinary meeting was the only factor independently associated with administration of chemotherapy.
Adjuvant chemotherapy for stage-III colon cancer is used extensively for patients under 75 years of age. However, many elderly patients do not receive such treatment. On the other hand, a substantial percentage of stage-II colon cancer patients receive adjuvant chemotherapy despite its uncertain benefits.
SourceAvailable from: Simone Mathoulin-Pelissier[Show abstract] [Hide abstract]
ABSTRACT: Background Colorectal cancer (CRC) care has improved considerably, particularly since the implementation of a quality of care program centered on national evidence-based guidelines. Formal quality assessment is however still needed. The aim of this research was to identify factors associated with practice variation in CRC patient care. Methods CRC patients identified from all cancer centers in South-West France were included. We investigated variations in practices (from diagnosis to surgery), and compliance with recommended guidelines for colon and rectal cancer. We identified factors associated with three colon cancer practice variations potentially linked to better survival: examination of ≥12 lymph nodes (LN), non-use and use of adjuvant chemotherapy for stage II and stage III patients, respectively. Results We included 1,206 patients, 825 (68%) with colon and 381 (32%) with rectal cancer, from 53 hospitals. Compliance was high for resection, pathology report, LN examination, and chemotherapy use for stage III patients. In colon cancer, 26% of stage II patients received adjuvant chemotherapy and 71% of stage III patients. 84% of stage US T3T4 rectal cancer patients received pre-operative radiotherapy. In colon cancer, factors associated with examination of ≥12 LNs were: lower ECOG score, advanced stage and larger hospital volume; factors negatively associated were: left sided tumor location and one hospital district. Use of chemotherapy in stage II patients was associated with younger age, advanced stage, emergency setting and care structure (private and location); whereas under-use in stage III patients was associated with advanced age, presence of comorbidities and private hospitals. Conclusions Although some changes in practices may have occurred since this observational study, these findings represent the most recent report on practices in CRC in this region, and offer a useful methodological approach for assessing quality of care. Guideline compliance was high, although some organizational factors such as hospital size or location influence practice variation. These factors should be the focus of any future guideline implementation.BMC Cancer 07/2012; 12(1). DOI:10.1186/1471-2407-12-297 · 3.32 Impact Factor
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ABSTRACT: Net survival, the survival that might occur if cancer was the only cause of death, is a major epidemiological indicator. Recent findings have shown that the classical methods used for the estimation of net survival from cancer registry data, referred as to "relative-survival methods," provided biased estimates. The aim of this study was to provide, for the first time, long-term net survival rates for colorectal cancer by using a population-based digestive cancer registry. This study is a population-based cancer registry analysis. The recently proposed unbiased nonparametric Pohar-Perme estimator was used. Overall, 14,715 colorectal cancers diagnosed between 1976 and 2005 and registered in the population-based digestive cancer registry of Burgundy (France) were included. The primary outcome measured was cancer net survival, ie, the survival that might occur if all risks of dying of other causes than cancer were removed : Ten-year net survival increased from 31% during the 1976 to 1985 period to 47% during the 1986 to 1995 period and then leveled out (48% during the 1996-2005 period). There was a major improvement in 10-year net survival after resection for cure and for stage I to III. It was striking for stage III cancers, for which 10-year net survival increased from 21% (1976-1985) to 49% (1996-2005). The corresponding net survivals were 70% and 87% for stage I and 49% and 65% for stage II. These trends can be related to the decrease in operative mortality, the increase in the proportion of patients resected for cure, and the improvement in stage at diagnosis. They were mainly seen between 1976 and 1995, explaining why survival leveled out after 1995. The study was limited by its retrospective and population-based nature. Further improvements for colorectal cancer management can be expected from more effective treatments and from the implementation of organized cancer screening.Diseases of the Colon & Rectum 10/2013; 56(10):1118-24. DOI:10.1097/DCR.0b013e31829f3436 · 3.20 Impact Factor
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ABSTRACT: Deuxième cancer chez l’homme et troisième chez la femme en France, le cancer colorectal est un véritable enjeu de santé publique. Son incidence est en augmentation ces dernières années et malgré le développement de nouvelles thérapeutiques, il garde un mauvais pronostic. Grâce, entre autres, à la mise en place d’une campagne de dépistage nationale par Hémoccult®, son diagnostic se fait à un stade de plus en plus précoce, rendant possible une résection chirurgicale à but curatif et la réalisation d’une chimiothérapie adjuvante. Dans le cas de cancers coliques de stade III opérés, une chimiothérapie adjuvante par FOLFOX 4 doit être proposée. Néanmoins, compte tenu des toxicités de cette chimiothérapie, de l’âge parfois élevé des patients, de comorbidités importantes ou de complications post-chirurgicales, celle-ci ne peut parfois pas être réalisée. Quels sont les principaux facteurs pronostiques des cancers colorectaux opérés permettant de discuter la chimiothérapie adjuvante ? La classification TNM, le nombre de ganglions examinés, le statut MSI et la présence ou non d’une perforation ou d’un envahissement péri-nerveuse, lymphatique ou veineuse sont les facteurs pronostiques validés. Quelles sont les alternatives à la chimiothérapie adjuvante par FOLFOX 4 ?La Presse Médicale 01/2012; DOI:10.1016/j.lpm.2011.03.021 · 1.17 Impact Factor