Use of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort
Use of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort
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DOI：
10.1200/jco.2003.06.178
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发表时间：
2003-04-01
影响因子：
45.3
通讯作者：
Wright, WE
中科院分区：
文献类型：
--
作者：
Ayanian, JZ;Zaslavsky, AM;Wright, WE
目的：随机试验表明，辅助化疗可提高III期结肠癌患者的生存率，化疗联合放疗可提高II期或III期直肠癌患者的生存率。这项以人群为基础的研究旨在评估使用这些治疗在临床practice.Patients和方法：从加州癌症登记处，我们确定了所有患者在1996年至1997年诊断为III期结肠癌（n = 1，422）和11期或III直肠癌（n = 534）在22个北方加州县。为了补充关于辅助治疗的注册数据并确定不使用辅助治疗的原因，我们调查了1，449名患者（74%）的医生或审查了办公室记录。结果：化疗率因年龄而异，从88%（年龄< 55岁）到11%（年龄大于或等于85岁），放射治疗的变化相似。根据人口统计学、临床和医院特征进行调整后，老年和未婚患者较少使用化疗，老年患者、黑人患者和最初在低容量医院接受治疗的患者较少使用放射治疗。调整后的化疗率在各个医院之间差异显著（P <0.01）：分别为79%和51%，高于和低于平均水平（67%）一个标准差。医生不提供辅助治疗的原因包括患者拒绝（化疗30%，放疗22%），共病（分别为22%和14%），或缺乏临床适应症（分别为22%和45%）。结直肠癌辅助治疗的使用因年龄、种族、婚姻状况、医院容量和单个医院而有很大差异，这表明有机会改善护理。随着辅助治疗数据的增加，基于人群的登记可能成为监测癌症护理质量的宝贵资源。(C)2003年，美国临床肿瘤学会。
Purpose: Randomized trials have demonstrated that adjuvant chemotherapy improves survival for patients with stage III colon cancer and that chemotherapy combined with radiation therapy improves survival for patients with stage II or III rectal cancer. This population-based study was designed to assess use of these treatments in clinical practice.Patients and Methods: From the California Cancer Registry, we identified all patients diagnosed during 1996 to 1997 with stage III colon cancer (n = 1,422) and stage 11 or III rectal cancer (n = 534) in 22 northern California counties. To supplement registry data on adjuvant therapies and ascertain reasons they were not used, we surveyed physicians or reviewed office records for 1,449 patients (74%).Results: Chemotherapy rates varied widely by age from 88% (age < 55 years) to 11% (age greater than or equal to 85 years), and radiation therapy varied similarly. Adjusting for demographic, clinical, and hospital characteristics, chemotherapy was used less often among older and unmarried patients, and radiation therapy was used less often among older patients, black patients, and those initially treated in low-volume hospitals. Adjusted rates of chemotherapy, varied significantly (P < .01) among individual hospitals: 79% and 51%, respectively, at one SD above and below average (67%). Physicians' reasons for not providing adjuvant therapy included patient refusal (30% for chemotherapy, 22% for radiation therapy), comorbid illness (22% and 14%, respectively), or lack of clinical indication (22% and 45%, respectively).Conclusion: Use of adjuvant therapy for colorectal cancer varies substantially by age, race, marital status, hospital volume, and individual hospital, indicating opportunities to improve care. With enhanced data on adjuvant therapies, population-based registries could become a valuable resource for monitoring the quality of cancer care. (C) 2003 by American Society of Clinical Oncology.