Postoperative adjuvant chemotherapy use in patients with stage II/III rectal cancer treated with neoadjuvant therapy

A National Comprehensive Cancer Network analysis

Polina Khrizman, Joyce C. Niland, Anna Ter Veer, Dana Milne, Kelli Bullard Dunn, William E. Carson, Paul F. Engstrom, Stephen Shibata, John M. Skibber, Martin R. Weiser, Deborah Schrag, Al B Benson III*

*Corresponding author for this work

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Purpose: Practice guidelines recommend that patients who receive neoadjuvant chemotherapy and radiation for locally advanced rectal cancer complete postoperative adjuvant systemic chemotherapy, irrespective of tumor downstaging. Patients and Methods: The National Comprehensive Cancer Network (NCCN) Colorectal Cancer Database tracks longitudinal care for patients treated at eight specialty cancer centers across the United States and was used to evaluate how frequently patients with rectal cancer who were treated with neoadjuvant chemotherapy also received postoperative systemic chemotherapy. Patient and tumor characteristics were examined in a multivariable logistic regression model. Results: Between September 2005 and December 2010, 2,073 patients with stage II/III rectal cancer were enrolled in the database. Of these, 1,193 patients receiving neoadjuvant chemoradiotherapy were in the analysis, including 203 patients not receiving any adjuvant chemotherapy. For those seen by a medical oncologist, the most frequent reason chemotherapy was not recommended was comorbid illness (25 of 50, 50%); the most frequent reason chemotherapy was not received even though it was recommended or discussed was patient refusal (54 of 74, 73%). After controlling for NCCN Cancer Center and clinical TNM stage in a multivariable logistic model, factors significantly associated with not receiving adjuvant chemotherapy were age, Eastern Cooperative Oncology Group performance status ≥ 1, on Medicaid or indigent compared with private insurance, complete pathologic response, presence of re-operation/wound infection, and no closure of ileostomy/colostomy. Conclusion: Even at specialty cancer centers, a sizeable minority of patients with rectal cancer treated with curative-intent neoadjuvant chemoradiotherapy do not complete postoperative chemotherapy. Strategies to facilitate the ability to complete this third and final component of curative intent treatment are necessary.

Original languageEnglish (US)
Pages (from-to)30-38
Number of pages9
JournalJournal of Clinical Oncology
Volume31
Issue number1
DOIs
StatePublished - Jan 1 2013

Fingerprint

Neoadjuvant Therapy
Adjuvant Chemotherapy
Rectal Neoplasms
Drug Therapy
Neoplasms
Logistic Models
Chemoradiotherapy
Databases
Ileostomy
Colostomy
Medicaid
Wound Infection
Poverty
Insurance
Practice Guidelines
Colorectal Neoplasms
Patient Care
Radiation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Khrizman, Polina ; Niland, Joyce C. ; Ter Veer, Anna ; Milne, Dana ; Dunn, Kelli Bullard ; Carson, William E. ; Engstrom, Paul F. ; Shibata, Stephen ; Skibber, John M. ; Weiser, Martin R. ; Schrag, Deborah ; Benson III, Al B. / Postoperative adjuvant chemotherapy use in patients with stage II/III rectal cancer treated with neoadjuvant therapy : A National Comprehensive Cancer Network analysis. In: Journal of Clinical Oncology. 2013 ; Vol. 31, No. 1. pp. 30-38.
@article{d81aef79d9ff4ccfa33a6af175de2f5c,
title = "Postoperative adjuvant chemotherapy use in patients with stage II/III rectal cancer treated with neoadjuvant therapy: A National Comprehensive Cancer Network analysis",
abstract = "Purpose: Practice guidelines recommend that patients who receive neoadjuvant chemotherapy and radiation for locally advanced rectal cancer complete postoperative adjuvant systemic chemotherapy, irrespective of tumor downstaging. Patients and Methods: The National Comprehensive Cancer Network (NCCN) Colorectal Cancer Database tracks longitudinal care for patients treated at eight specialty cancer centers across the United States and was used to evaluate how frequently patients with rectal cancer who were treated with neoadjuvant chemotherapy also received postoperative systemic chemotherapy. Patient and tumor characteristics were examined in a multivariable logistic regression model. Results: Between September 2005 and December 2010, 2,073 patients with stage II/III rectal cancer were enrolled in the database. Of these, 1,193 patients receiving neoadjuvant chemoradiotherapy were in the analysis, including 203 patients not receiving any adjuvant chemotherapy. For those seen by a medical oncologist, the most frequent reason chemotherapy was not recommended was comorbid illness (25 of 50, 50{\%}); the most frequent reason chemotherapy was not received even though it was recommended or discussed was patient refusal (54 of 74, 73{\%}). After controlling for NCCN Cancer Center and clinical TNM stage in a multivariable logistic model, factors significantly associated with not receiving adjuvant chemotherapy were age, Eastern Cooperative Oncology Group performance status ≥ 1, on Medicaid or indigent compared with private insurance, complete pathologic response, presence of re-operation/wound infection, and no closure of ileostomy/colostomy. Conclusion: Even at specialty cancer centers, a sizeable minority of patients with rectal cancer treated with curative-intent neoadjuvant chemoradiotherapy do not complete postoperative chemotherapy. Strategies to facilitate the ability to complete this third and final component of curative intent treatment are necessary.",
author = "Polina Khrizman and Niland, {Joyce C.} and {Ter Veer}, Anna and Dana Milne and Dunn, {Kelli Bullard} and Carson, {William E.} and Engstrom, {Paul F.} and Stephen Shibata and Skibber, {John M.} and Weiser, {Martin R.} and Deborah Schrag and {Benson III}, {Al B}",
year = "2013",
month = "1",
day = "1",
doi = "10.1200/JCO.2011.40.3188",
language = "English (US)",
volume = "31",
pages = "30--38",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "1",

}

Khrizman, P, Niland, JC, Ter Veer, A, Milne, D, Dunn, KB, Carson, WE, Engstrom, PF, Shibata, S, Skibber, JM, Weiser, MR, Schrag, D & Benson III, AB 2013, 'Postoperative adjuvant chemotherapy use in patients with stage II/III rectal cancer treated with neoadjuvant therapy: A National Comprehensive Cancer Network analysis', Journal of Clinical Oncology, vol. 31, no. 1, pp. 30-38. https://doi.org/10.1200/JCO.2011.40.3188

Postoperative adjuvant chemotherapy use in patients with stage II/III rectal cancer treated with neoadjuvant therapy : A National Comprehensive Cancer Network analysis. / Khrizman, Polina; Niland, Joyce C.; Ter Veer, Anna; Milne, Dana; Dunn, Kelli Bullard; Carson, William E.; Engstrom, Paul F.; Shibata, Stephen; Skibber, John M.; Weiser, Martin R.; Schrag, Deborah; Benson III, Al B.

In: Journal of Clinical Oncology, Vol. 31, No. 1, 01.01.2013, p. 30-38.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Postoperative adjuvant chemotherapy use in patients with stage II/III rectal cancer treated with neoadjuvant therapy

T2 - A National Comprehensive Cancer Network analysis

AU - Khrizman, Polina

AU - Niland, Joyce C.

AU - Ter Veer, Anna

AU - Milne, Dana

AU - Dunn, Kelli Bullard

AU - Carson, William E.

AU - Engstrom, Paul F.

AU - Shibata, Stephen

AU - Skibber, John M.

AU - Weiser, Martin R.

AU - Schrag, Deborah

AU - Benson III, Al B

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Purpose: Practice guidelines recommend that patients who receive neoadjuvant chemotherapy and radiation for locally advanced rectal cancer complete postoperative adjuvant systemic chemotherapy, irrespective of tumor downstaging. Patients and Methods: The National Comprehensive Cancer Network (NCCN) Colorectal Cancer Database tracks longitudinal care for patients treated at eight specialty cancer centers across the United States and was used to evaluate how frequently patients with rectal cancer who were treated with neoadjuvant chemotherapy also received postoperative systemic chemotherapy. Patient and tumor characteristics were examined in a multivariable logistic regression model. Results: Between September 2005 and December 2010, 2,073 patients with stage II/III rectal cancer were enrolled in the database. Of these, 1,193 patients receiving neoadjuvant chemoradiotherapy were in the analysis, including 203 patients not receiving any adjuvant chemotherapy. For those seen by a medical oncologist, the most frequent reason chemotherapy was not recommended was comorbid illness (25 of 50, 50%); the most frequent reason chemotherapy was not received even though it was recommended or discussed was patient refusal (54 of 74, 73%). After controlling for NCCN Cancer Center and clinical TNM stage in a multivariable logistic model, factors significantly associated with not receiving adjuvant chemotherapy were age, Eastern Cooperative Oncology Group performance status ≥ 1, on Medicaid or indigent compared with private insurance, complete pathologic response, presence of re-operation/wound infection, and no closure of ileostomy/colostomy. Conclusion: Even at specialty cancer centers, a sizeable minority of patients with rectal cancer treated with curative-intent neoadjuvant chemoradiotherapy do not complete postoperative chemotherapy. Strategies to facilitate the ability to complete this third and final component of curative intent treatment are necessary.

AB - Purpose: Practice guidelines recommend that patients who receive neoadjuvant chemotherapy and radiation for locally advanced rectal cancer complete postoperative adjuvant systemic chemotherapy, irrespective of tumor downstaging. Patients and Methods: The National Comprehensive Cancer Network (NCCN) Colorectal Cancer Database tracks longitudinal care for patients treated at eight specialty cancer centers across the United States and was used to evaluate how frequently patients with rectal cancer who were treated with neoadjuvant chemotherapy also received postoperative systemic chemotherapy. Patient and tumor characteristics were examined in a multivariable logistic regression model. Results: Between September 2005 and December 2010, 2,073 patients with stage II/III rectal cancer were enrolled in the database. Of these, 1,193 patients receiving neoadjuvant chemoradiotherapy were in the analysis, including 203 patients not receiving any adjuvant chemotherapy. For those seen by a medical oncologist, the most frequent reason chemotherapy was not recommended was comorbid illness (25 of 50, 50%); the most frequent reason chemotherapy was not received even though it was recommended or discussed was patient refusal (54 of 74, 73%). After controlling for NCCN Cancer Center and clinical TNM stage in a multivariable logistic model, factors significantly associated with not receiving adjuvant chemotherapy were age, Eastern Cooperative Oncology Group performance status ≥ 1, on Medicaid or indigent compared with private insurance, complete pathologic response, presence of re-operation/wound infection, and no closure of ileostomy/colostomy. Conclusion: Even at specialty cancer centers, a sizeable minority of patients with rectal cancer treated with curative-intent neoadjuvant chemoradiotherapy do not complete postoperative chemotherapy. Strategies to facilitate the ability to complete this third and final component of curative intent treatment are necessary.

UR - http://www.scopus.com/inward/record.url?scp=84871734509&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84871734509&partnerID=8YFLogxK

U2 - 10.1200/JCO.2011.40.3188

DO - 10.1200/JCO.2011.40.3188

M3 - Article

VL - 31

SP - 30

EP - 38

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 1

ER -