Dr Nancy Keating and colleagues from the USA surveyed cancer physicians to understand how patients' age and comorbidity influence adjuvant chemotherapy recommendations.
The research team also assessed whether physician or practice characteristics affect these recommendations.
|Few physician or practice characteristics were associated with recommendations|
|Journal of Clinical Oncology|
The team conducted a national survey of surgeons and medical oncologists caring for patients with colorectal cancer regarding whether they would recommend adjuvant chemotherapy for hypothetical patients with stage 3 colon cancer.
The patients varied by age, at 55 vs 80 years, and had either no or moderate comorbid illness or congestive heart failure.
The team used repeated measures logistic regression to assess the influence of patient, physician, and practice characteristics on chemotherapy recommendations.
The team found that of 1,096 physicians, nearly all recommended chemotherapy for patients who were 55 years old with no comorbidity.
The researchers noted that 89% of physicians recommended chemotherapy for 55-year old patients with moderate congestive heart failure.
The team found that 25% of physicians recommended chemotherapy for 55-year-old patients with severe congestive heart failure.
About 93% of physicians recommended chemotherapy for 80 year old patients with no comorbidity.
For 80-year-old patients with moderate or severe congestive heart failure, 47% and 9% of physicians recommended chemotherapy, respectively.
The team found that younger physicians were more likely than others to recommend adjuvant chemotherapy overall.
However, the research team noted that physician factors explained little of the variability in recommendations.
Dr Keating's team concluded, "Physicians agree with guidelines recommending adjuvant chemotherapy for young, healthy patients with stage 3 colon cancer.
"However, recommendations differ widely on recommendations for patients who are older and sicker."
"Few physician or practice characteristics were associated with recommendations."
"For older and sicker patients, the individual physicians seen may have a substantial impact on the likelihood of receiving chemotherapy."
"Understanding better the sources of variation not explained by patients' clinical characteristics may allow improved tailoring of therapy to patients most likely to benefit."