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Reasons physicians do not recommend and patients refuse adjuvant chemotherapy for stage III colon cancer: a population based chart review.

El Shayeb M, Scarfe A, Yasui Y, Winget M - BMC Res Notes (2012)

Bottom Line: Despite this, large proportions of patients do not receive adjuvant chemotherapy.Some co-morbidities are clinical indications for not receiving adjuvant chemotherapy, however, the high percentage of patients who were not recommended adjuvant chemotherapy due to co-morbidities according to clinical notes but who had a low Charlson co-morbidity score suggests variation in practice patterns of consulting oncologists.In addition, patients' reasons for refusing treatment need to be systematically assessed to ensure patients' preferences and treatment benefits are properly weighed when making treatment decisions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health Sciences, School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, Edmonton, AB, Canada T6G 1 C9.

ABSTRACT

Background: Surgery followed by adjuvant chemotherapy has been the standard of care for the treatment of stage III colon cancer since the early 1990's. Despite this, large proportions of patients do not receive adjuvant chemotherapy. We aimed to identify physicians' and patients' reasons for treatment decisions.

Methods: A retrospective population based study was conducted that included all surgically treated stage III colon cancer patients diagnosed in Alberta between 2002 and 2005 who had an oncologist-consult to discuss post-surgical treatment options. Patient demographics and stage were obtained from the Alberta Cancer Registry. Chart reviews were conducted to extract treatment details, the oncologists' reasons for not recommending chemotherapy, and patients' reasons for refusing chemotherapy. The number and proportion of patients who were not recommended or refused chemotherapy were calculated.

Results: A total of 613 patients had surgery followed by an oncologist-consult. Overall, 168 (27%) patients did not receive chemotherapy. It was not recommended for 111 (18%) patients; the most frequent reason was presence of one or more co-morbidities (34%) or combination of co-morbidity and age or frailty (22%). Fifty-eight (9%) patients declined chemotherapy, 22% of whom declined due to concerns about toxicity.

Conclusion: Some co-morbidities are clinical indications for not receiving adjuvant chemotherapy, however, the high percentage of patients who were not recommended adjuvant chemotherapy due to co-morbidities according to clinical notes but who had a low Charlson co-morbidity score suggests variation in practice patterns of consulting oncologists. In addition, patients' reasons for refusing treatment need to be systematically assessed to ensure patients' preferences and treatment benefits are properly weighed when making treatment decisions.

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Proportion of patients with stage III colon cancer in Alberta who were not recommended and/or refused adjuvant chemotherapy.
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Figure 1: Proportion of patients with stage III colon cancer in Alberta who were not recommended and/or refused adjuvant chemotherapy.

Mentions: Figure 1 shows the proportion of patients for whom chemotherapy was not recommended by their oncologist and the proportion of patients that refused adjuvant chemotherapy in relation to the timing of their consultation with respect to their surgery. Overall 27% (168) of the patients did not commence adjuvant chemotherapy. It was not recommended for 111 (18%) patients and 58 (9%) patients refused adjuvant chemotherapy. Only one patient decided to pursue adjuvant chemotherapy despite not being recommended by the oncologist. Of interest is that 26 patients had a consultation more than 12 weeks after their surgery, the maximum time that should elapse before initiating adjuvant chemotherapy as per treatment guidelines [12]; 16 of these patients were recommended chemotherapy and 12 of them initiated it. Delayed or late consult was not the reason for not recommending adjuvant chemotherapy to any of patients who had a consultation more than 12 weeks post-surgery.


Reasons physicians do not recommend and patients refuse adjuvant chemotherapy for stage III colon cancer: a population based chart review.

El Shayeb M, Scarfe A, Yasui Y, Winget M - BMC Res Notes (2012)

Proportion of patients with stage III colon cancer in Alberta who were not recommended and/or refused adjuvant chemotherapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3405463&req=5

Figure 1: Proportion of patients with stage III colon cancer in Alberta who were not recommended and/or refused adjuvant chemotherapy.
Mentions: Figure 1 shows the proportion of patients for whom chemotherapy was not recommended by their oncologist and the proportion of patients that refused adjuvant chemotherapy in relation to the timing of their consultation with respect to their surgery. Overall 27% (168) of the patients did not commence adjuvant chemotherapy. It was not recommended for 111 (18%) patients and 58 (9%) patients refused adjuvant chemotherapy. Only one patient decided to pursue adjuvant chemotherapy despite not being recommended by the oncologist. Of interest is that 26 patients had a consultation more than 12 weeks after their surgery, the maximum time that should elapse before initiating adjuvant chemotherapy as per treatment guidelines [12]; 16 of these patients were recommended chemotherapy and 12 of them initiated it. Delayed or late consult was not the reason for not recommending adjuvant chemotherapy to any of patients who had a consultation more than 12 weeks post-surgery.

Bottom Line: Despite this, large proportions of patients do not receive adjuvant chemotherapy.Some co-morbidities are clinical indications for not receiving adjuvant chemotherapy, however, the high percentage of patients who were not recommended adjuvant chemotherapy due to co-morbidities according to clinical notes but who had a low Charlson co-morbidity score suggests variation in practice patterns of consulting oncologists.In addition, patients' reasons for refusing treatment need to be systematically assessed to ensure patients' preferences and treatment benefits are properly weighed when making treatment decisions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health Sciences, School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, Edmonton, AB, Canada T6G 1 C9.

ABSTRACT

Background: Surgery followed by adjuvant chemotherapy has been the standard of care for the treatment of stage III colon cancer since the early 1990's. Despite this, large proportions of patients do not receive adjuvant chemotherapy. We aimed to identify physicians' and patients' reasons for treatment decisions.

Methods: A retrospective population based study was conducted that included all surgically treated stage III colon cancer patients diagnosed in Alberta between 2002 and 2005 who had an oncologist-consult to discuss post-surgical treatment options. Patient demographics and stage were obtained from the Alberta Cancer Registry. Chart reviews were conducted to extract treatment details, the oncologists' reasons for not recommending chemotherapy, and patients' reasons for refusing chemotherapy. The number and proportion of patients who were not recommended or refused chemotherapy were calculated.

Results: A total of 613 patients had surgery followed by an oncologist-consult. Overall, 168 (27%) patients did not receive chemotherapy. It was not recommended for 111 (18%) patients; the most frequent reason was presence of one or more co-morbidities (34%) or combination of co-morbidity and age or frailty (22%). Fifty-eight (9%) patients declined chemotherapy, 22% of whom declined due to concerns about toxicity.

Conclusion: Some co-morbidities are clinical indications for not receiving adjuvant chemotherapy, however, the high percentage of patients who were not recommended adjuvant chemotherapy due to co-morbidities according to clinical notes but who had a low Charlson co-morbidity score suggests variation in practice patterns of consulting oncologists. In addition, patients' reasons for refusing treatment need to be systematically assessed to ensure patients' preferences and treatment benefits are properly weighed when making treatment decisions.

Show MeSH
Related in: MedlinePlus