Complicated postoperative recovery increases omission, delay and discontinuation of adjuvant chemotherapy in patients with Stage III colon cancer

• Published in: Colorectal disease Vol. 15; no. 10; pp. e582 - e591
• Main Authors: van der Geest, L. G. M., Portielje, J. E. A., Wouters, M. W. J. M., Weijl, N. I., Tanis, B. C., Tollenaar, R. A. E. M., Struikmans, H., Nortier, J. W. R.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-10-2013
• Subjects: adjuvant chemotherapy; Age Factors; Aged; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Carcinoma - drug therapy; Carcinoma - pathology; Carcinoma - surgery; Chemotherapy, Adjuvant; Colon cancer; Colonic Neoplasms - drug therapy; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; Comorbidity; delay; discontinuation; Emergencies; Female; Humans; Length of Stay; Male; Middle Aged; Neoplasm Grading; Neoplasm Staging; Postoperative Complications; postoperative recovery; Reoperation; Sex Factors; Social Class; Stage III; Time Factors; Withholding Treatment; Stage III; adjuvant chemotherapy; Colon cancer; delay; postoperative recovery; discontinuation
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.12288

Aim
The study included investigation of factors determining suboptimal adjuvant chemotherapy of patients diagnosed with Stage III colon cancer.
Method
All 606 patients diagnosed with Stage III colon cancer between 2006 and 2008 in the western part of the Netherlands were included. Patient [gender, age, comorbidity and socio‐economic status (SES)], tumour (location, stage and grade) and treatment (emergency surgery, laparoscopic surgery, reoperation, hospital stay and multidisciplinary meeting) factors were examined in logistic regression analyses predicting a complicated postoperative period and omission, delay and discontinuation of adjuvant chemotherapy.
Results
Overall, 27% of all patients experienced a complicated postoperative period, which was independently associated with emergency surgery, older age, multiple comorbidity, male gender and poor tumour grade. Of patients who survived this period, 60% received chemotherapy. Chemotherapy was omitted more often in women, the elderly and in patients with Stage IIIB, reoperation, prolonged hospital stay and (borderline) after open surgery. Of patients who received chemotherapy, 86% started within 8 weeks after surgery. Patients with a higher SES, reoperation and prolonged hospital stay had a higher probability of a delayed start. Sixty‐seven per cent of patients completed their chemotherapy. For women, elderly patients and patients with prolonged hospital stay a higher probability of discontinuation was noted.
Conclusion
Age was the most important predictive factor for receiving adjuvant chemotherapy. However, at all ages, complicated postoperative recovery negatively influenced the administration of chemotherapy to Stage III colon cancer patients, as well as a timely start and completion of chemotherapy.