Adherence to Clinical Practice Guidelines for Adjuvant Chemotherapy for Colorectal Cancer in a Canadian Province: A Population-Based Analysis
Adherence to Clinical Practice Guidelines for Adjuvant Chemotherapy for Colorectal Cancer in a Canadian Province: A Population-Based Analysis
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DOI：
10.1200/jop.2012.000578
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发表时间：
2012-07-01
影响因子：
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通讯作者：
Porter, Geoff
中科院分区：
文献类型：
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作者：
Rayson, Daniel;Urquhart, Robin;Porter, Geoff
目的：临床实践指南（CPG）建议结直肠癌（CRC）根治性手术后进行辅助化疗。研究表明，对辅助治疗CPG的依从率各不相同。本研究旨在确定2001年至2005年新斯科舍省在CRC手术后12周内接受CPG一致性辅助化疗的患者比例，并确定与手术后12周以上接受化疗或未接受化疗相关的因素。接受根治性手术的IIB或III期结肠癌或II或III期直肠癌患者-新斯科舍省的意向手术是通过省癌症登记处确定的，并匿名链接到14个行政卫生数据库。进行图表审查，以获得化疗数据和未接受化疗的原因。Logistic回归分析用于确定与接受化疗和满足12周基准的独立相关因素（P <0.05）。结果：共确定了1，151例患者，其中59%接受化疗。接受化疗的预测因素为男性、年龄< 75岁、手术后30天内无再入院、III期疾病、既往无癌症诊断和直肠癌。在接受化疗的679名患者中，479名（72%）达到了12周的基准，男性、城市居住、较少的社会剥夺、结肠癌和住院时间延长是重要因素。没有接受化疗的472例患者中，最常见的原因nonrecipient是没有咨询与医学肿瘤学家（53%）。结论：一些因素影响坚持辅助化疗CPGs CRC，并应纳入未来的工作，新的方案进入临床实践。
Purpose: Clinical practice guidelines (CPGs) recommend adjuvant chemotherapy after curative-intent surgery for colorectal cancer (CRC). Studies have shown variable rates of adherence to adjuvant therapy CPGs. This study sought to determine the proportion of patients in Nova Scotia receiving CPG-concordant adjuvant chemotherapy within 12 weeks of surgery for CRC in 2001 to 2005, and to identify factors associated with chemotherapy receipt beyond 12 weeks from surgery or chemotherapy nonreceipt.Methods: Patients with stages IIB or III colon or stages II or III rectal cancer who underwent curative-intent surgery in Nova Scotia were identified through the provincial cancer registry and anonymously linked to 14 administrative health databases. Chart review was conducted to obtain chemotherapy data and reasons for chemotherapy nonreceipt. Logistic regression was used to identify factors independently associated with receipt of chemotherapy and meeting the 12-week benchmark (P < .05).Results: A total of 1,151 patients were identified, of whom 59% received chemotherapy. Factors predicting chemotherapy receipt were male sex, age < 75 years, no hospital readmission within 30 days of surgery, stage III disease, no prior cancer diagnosis, and rectal cancer. Of the 679 patients who received chemotherapy, 479 (72%) met the 12-week benchmark, with male sex, urban residence, less social deprivation, colon cancer and increased length of hospital stay as significant factors. Of the 472 patients who did not receive chemotherapy, the most common reason for nonreceipt was no consultation with a medical oncologist (53%).Conclusion: A number of factors influence adherence to adjuvant chemotherapy CPGs for CRC and should be incorporated in future work as novel regimens enter clinical practice.