A population-based study of adjuvant chemotherapy for stage-II and -III colon cancers

Registre Bourguignon des Cancers Digestifs, Inserm U866, Université de Bourgogne, CHU de Dijon, BP 87900, 21079 Dijon cedex, France.
Gastroentérologie Clinique et Biologique (Impact Factor: 1.14). 02/2010; 34(2):144-9. DOI: 10.1016/j.gcb.2009.08.012
Source: PubMed


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.

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    • "Studies were conducted in the US [12,13,26,39–44], UK [45] [46] [47] [48] [49], Australia [50] [51] [52], France [53] [54], Sweden [55] [56], The Netherlands [57] [58], New Zealand [59] [60], Germany [61] and Denmark [62]. Two studies recruited patients with a range of cancer diagnoses [41] [48]. "
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    ABSTRACT: Background: Conducting regular multidisciplinary team (MDT) meetings requires significant investment of time and finances. It is thus important to assess the empirical benefits of such practice. A systematic review was conducted to evaluate the literature regarding the impact of MDT meetings on patient assessment, management and outcomes in oncology settings. Methods: Relevant studies were identified by searching OVID MEDLINE, PsycINFO, and EMBASE databases from 1995 to April 2015, using the keywords: multidisciplinary team meeting* OR multidisciplinary discussion* OR multidisciplinary conference* OR case review meeting* OR multidisciplinary care forum* OR multidisciplinary tumour board* OR case conference* OR case discussion* AND oncology OR cancer. Studies were included if they assessed measurable outcomes, and used a comparison group and/or a pre- and post-test design. Results: Twenty-seven articles met inclusion criteria. There was limited evidence for improved survival outcomes of patients discussed at MDT meetings. Between 4% and 45% of patients discussed at MDT meetings experienced changes in diagnostic reports following the meeting. Patients discussed at MDT meetings were more likely to receive more accurate and complete pre-operative staging, and neo-adjuvant/adjuvant treatment. Quality of studies was affected by selection bias and the use of historical cohorts impacted study quality. Conclusions: MDT meetings impact upon patient assessment and management practices. However, there was little evidence indicating that MDT meetings resulted in improvements in clinical outcomes. Future research should assess the impact of MDT meetings on patient satisfaction and quality of life, as well as, rates of cross-referral between disciplines.
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    • "We examine differences across patient-, tumor- and hospital-related factors using 27 criteria (11 for colon and 16 for rectal cancer) to describe the quality of colorectal cancer care. We also use statistical models to investigate factors linked to three specific quality indicators identified by the National Quality Forum/American College of Surgeons/Commission on Cancer and National Comprehensive Cancer Network (NCCN)/American Society of Clinical Oncology [11] and potentially linked to better survival: examination of ≥12 lymph nodes (LN) [12,13], use of adjuvant chemotherapy for stage II patients [14] and non-use for stage III patients [15]. "
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