Following oncologic resection, adjuvant chemotherapy is associated with decreased recurrence and improved survival in stage 3 colon cancer.
However, there is controversy regarding its use in stage 2 colon cancer with high-risk features.
Consensus guidelines recommend no adjuvant chemotherapy in the absence of these high-risk features.
Dr Meghan Daly and colleagues examined hospital characteristics associated with poor risk-adjusted, stage-specific guideline compliance for the use of adjuvant chemotherapy in stage 3 and low-risk stage 2 colon cancer.
The researchers identified patient and hospital factors associated with administration of adjuvant chemotherapy.
|The mean overall risk-adjusted adjuvant chemotherapy rate was 65% for stage 3|
|Diseases of the Colon & Rectum|
The team then calculated risk- and reliability-adjusted rates of chemotherapy use and observed-to-expected ratios in each hospital’s stage 2 low-risk and stage 3 patients.
Data were retrieved from the National Cancer Database.
The researchers selected 167,345 adult patients treated with oncologic resection for stage 2 to 3 colon cancer at 1395 hospitals between 2004 and 2010.
The team's primary outcome measured was receipt of adjuvant chemotherapy.
The research team found that the mean overall risk-adjusted adjuvant chemotherapy rate was 65% for stage 3, and 15% for low-risk stage 2.
Analysis of low outlier hospitals for stage 3 colon cancer, where adjuvant chemotherapy was underutilized, demonstrated that 63% were low-volume centers, and 51% were community centers.
Of high outlier hospitals for stage 2 low-risk disease, where adjuvant chemotherapy was overutilized, 87% were low-volume hospitals and 67% were community centers.
Dr Daly's team commented, "Following oncologic resection, administration of adjuvant chemotherapy for low-risk stage 2 and stage 3 disease varies substantially among hospitals in the United States."
'Outlier hospitals were most likely to be low-volume community centers."