Use of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort

John Z. Ayanian, Alan M. Zaslavsky, Charles S. Fuchs, Edward Guadagnoli, Cynthia M. Creech, Rosemary D Cress, Lilia C. O'Connor, Dee W. West, Mark E. Allen, Robert E. Wolf, William E. Wright

Research output: Contribution to journalArticle

259 Citations (Scopus)

Abstract

Purpose: Randomized trials have demonstrated that adjuvant chemotherapy improves survival for patients with stage III colon cancer and that chemotherapy combined with radiation therapy improves survival for patients with stage II or III rectal cancer. This population-based study was designed to assess use of these treatments in clinical practice. Patients and Methods: From the California Cancer Registry, we identified all patients diagnosed during 1996 to 1997 with stage III colon cancer (n = 1,422) and stage II or III rectal cancer (n = 534) in 22 northern California counties. To supplement registry data on adjuvant therapies and ascertain reasons they were not used, we surveyed physicians or reviewed office records for 1,449 patients (74%). Results: Chemotherapy rates varied widely by age from 88% (age < 55 years) to 11% (age > 85 years), and radiation therapy varied similarly. Adjusting for demographic, clinical, and hospital characteristics, chemotherapy was used less often among older and unmarried patients, and radiation therapy was used less often among older patients, black patients, and those initially treated in low-volume hospitals. Adjusted rates of chemotherapy varied significantly (P < .01) among individual hospitals: 79% and 51%, respectively, at one SD above and below average (67%). Physicians' reasons for not providing adjuvant therapy included patient refusal (30% for chemotherapy, 22% for radiation therapy), comorbid illness (22% and 14%, respectively), or lack of clinical indication (22% and 45%, respectively). Conclusion: Use of adjuvant therapy for colorectal cancer varies substantially by age, race, marital status, hospital volume, and individual hospital, indicating opportunities to improve care. With enhanced data on adjuvant therapies, population-based registries could become a valuable resource for monitoring the quality of cancer care.

Original languageEnglish (US)
Pages (from-to)1293-1300
Number of pages8
JournalJournal of Clinical Oncology
Volume21
Issue number7
DOIs
StatePublished - Apr 1 2003

Fingerprint

Adjuvant Chemotherapy
Colorectal Neoplasms
Radiotherapy
Population
Drug Therapy
Registries
Rectal Neoplasms
Colonic Neoplasms
Low-Volume Hospitals
Physicians
Therapeutics
Survival
Quality of Health Care
Marital Status
Neoplasms
Demography

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Ayanian, J. Z., Zaslavsky, A. M., Fuchs, C. S., Guadagnoli, E., Creech, C. M., Cress, R. D., ... Wright, W. E. (2003). Use of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort. Journal of Clinical Oncology, 21(7), 1293-1300. https://doi.org/10.1200/JCO.2003.06.178

Use of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort. / Ayanian, John Z.; Zaslavsky, Alan M.; Fuchs, Charles S.; Guadagnoli, Edward; Creech, Cynthia M.; Cress, Rosemary D; O'Connor, Lilia C.; West, Dee W.; Allen, Mark E.; Wolf, Robert E.; Wright, William E.

In: Journal of Clinical Oncology, Vol. 21, No. 7, 01.04.2003, p. 1293-1300.

Research output: Contribution to journalArticle

Ayanian, JZ, Zaslavsky, AM, Fuchs, CS, Guadagnoli, E, Creech, CM, Cress, RD, O'Connor, LC, West, DW, Allen, ME, Wolf, RE & Wright, WE 2003, 'Use of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort', Journal of Clinical Oncology, vol. 21, no. 7, pp. 1293-1300. https://doi.org/10.1200/JCO.2003.06.178
Ayanian, John Z. ; Zaslavsky, Alan M. ; Fuchs, Charles S. ; Guadagnoli, Edward ; Creech, Cynthia M. ; Cress, Rosemary D ; O'Connor, Lilia C. ; West, Dee W. ; Allen, Mark E. ; Wolf, Robert E. ; Wright, William E. / Use of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort. In: Journal of Clinical Oncology. 2003 ; Vol. 21, No. 7. pp. 1293-1300.
@article{6620611dbfb24ad3804bab01bd900c26,
title = "Use of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort",
abstract = "Purpose: Randomized trials have demonstrated that adjuvant chemotherapy improves survival for patients with stage III colon cancer and that chemotherapy combined with radiation therapy improves survival for patients with stage II or III rectal cancer. This population-based study was designed to assess use of these treatments in clinical practice. Patients and Methods: From the California Cancer Registry, we identified all patients diagnosed during 1996 to 1997 with stage III colon cancer (n = 1,422) and stage II or III rectal cancer (n = 534) in 22 northern California counties. To supplement registry data on adjuvant therapies and ascertain reasons they were not used, we surveyed physicians or reviewed office records for 1,449 patients (74{\%}). Results: Chemotherapy rates varied widely by age from 88{\%} (age < 55 years) to 11{\%} (age > 85 years), and radiation therapy varied similarly. Adjusting for demographic, clinical, and hospital characteristics, chemotherapy was used less often among older and unmarried patients, and radiation therapy was used less often among older patients, black patients, and those initially treated in low-volume hospitals. Adjusted rates of chemotherapy varied significantly (P < .01) among individual hospitals: 79{\%} and 51{\%}, respectively, at one SD above and below average (67{\%}). Physicians' reasons for not providing adjuvant therapy included patient refusal (30{\%} for chemotherapy, 22{\%} for radiation therapy), comorbid illness (22{\%} and 14{\%}, respectively), or lack of clinical indication (22{\%} and 45{\%}, respectively). Conclusion: Use of adjuvant therapy for colorectal cancer varies substantially by age, race, marital status, hospital volume, and individual hospital, indicating opportunities to improve care. With enhanced data on adjuvant therapies, population-based registries could become a valuable resource for monitoring the quality of cancer care.",
author = "Ayanian, {John Z.} and Zaslavsky, {Alan M.} and Fuchs, {Charles S.} and Edward Guadagnoli and Creech, {Cynthia M.} and Cress, {Rosemary D} and O'Connor, {Lilia C.} and West, {Dee W.} and Allen, {Mark E.} and Wolf, {Robert E.} and Wright, {William E.}",
year = "2003",
month = "4",
day = "1",
doi = "10.1200/JCO.2003.06.178",
language = "English (US)",
volume = "21",
pages = "1293--1300",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "7",

}

TY - JOUR

T1 - Use of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort

AU - Ayanian, John Z.

AU - Zaslavsky, Alan M.

AU - Fuchs, Charles S.

AU - Guadagnoli, Edward

AU - Creech, Cynthia M.

AU - Cress, Rosemary D

AU - O'Connor, Lilia C.

AU - West, Dee W.

AU - Allen, Mark E.

AU - Wolf, Robert E.

AU - Wright, William E.

PY - 2003/4/1

Y1 - 2003/4/1

N2 - Purpose: Randomized trials have demonstrated that adjuvant chemotherapy improves survival for patients with stage III colon cancer and that chemotherapy combined with radiation therapy improves survival for patients with stage II or III rectal cancer. This population-based study was designed to assess use of these treatments in clinical practice. Patients and Methods: From the California Cancer Registry, we identified all patients diagnosed during 1996 to 1997 with stage III colon cancer (n = 1,422) and stage II or III rectal cancer (n = 534) in 22 northern California counties. To supplement registry data on adjuvant therapies and ascertain reasons they were not used, we surveyed physicians or reviewed office records for 1,449 patients (74%). Results: Chemotherapy rates varied widely by age from 88% (age < 55 years) to 11% (age > 85 years), and radiation therapy varied similarly. Adjusting for demographic, clinical, and hospital characteristics, chemotherapy was used less often among older and unmarried patients, and radiation therapy was used less often among older patients, black patients, and those initially treated in low-volume hospitals. Adjusted rates of chemotherapy varied significantly (P < .01) among individual hospitals: 79% and 51%, respectively, at one SD above and below average (67%). Physicians' reasons for not providing adjuvant therapy included patient refusal (30% for chemotherapy, 22% for radiation therapy), comorbid illness (22% and 14%, respectively), or lack of clinical indication (22% and 45%, respectively). Conclusion: Use of adjuvant therapy for colorectal cancer varies substantially by age, race, marital status, hospital volume, and individual hospital, indicating opportunities to improve care. With enhanced data on adjuvant therapies, population-based registries could become a valuable resource for monitoring the quality of cancer care.

AB - Purpose: Randomized trials have demonstrated that adjuvant chemotherapy improves survival for patients with stage III colon cancer and that chemotherapy combined with radiation therapy improves survival for patients with stage II or III rectal cancer. This population-based study was designed to assess use of these treatments in clinical practice. Patients and Methods: From the California Cancer Registry, we identified all patients diagnosed during 1996 to 1997 with stage III colon cancer (n = 1,422) and stage II or III rectal cancer (n = 534) in 22 northern California counties. To supplement registry data on adjuvant therapies and ascertain reasons they were not used, we surveyed physicians or reviewed office records for 1,449 patients (74%). Results: Chemotherapy rates varied widely by age from 88% (age < 55 years) to 11% (age > 85 years), and radiation therapy varied similarly. Adjusting for demographic, clinical, and hospital characteristics, chemotherapy was used less often among older and unmarried patients, and radiation therapy was used less often among older patients, black patients, and those initially treated in low-volume hospitals. Adjusted rates of chemotherapy varied significantly (P < .01) among individual hospitals: 79% and 51%, respectively, at one SD above and below average (67%). Physicians' reasons for not providing adjuvant therapy included patient refusal (30% for chemotherapy, 22% for radiation therapy), comorbid illness (22% and 14%, respectively), or lack of clinical indication (22% and 45%, respectively). Conclusion: Use of adjuvant therapy for colorectal cancer varies substantially by age, race, marital status, hospital volume, and individual hospital, indicating opportunities to improve care. With enhanced data on adjuvant therapies, population-based registries could become a valuable resource for monitoring the quality of cancer care.

UR - http://www.scopus.com/inward/record.url?scp=0038175326&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0038175326&partnerID=8YFLogxK

U2 - 10.1200/JCO.2003.06.178

DO - 10.1200/JCO.2003.06.178

M3 - Article

C2 - 12663717

AN - SCOPUS:0038175326

VL - 21

SP - 1293

EP - 1300

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 7

ER -