Adjuvant chemotherapy for stage III colon cancer: do physicians agree about the importance of patient age and comorbidity?

Full Abstract

PURPOSE: We surveyed cancer physicians to understand how patients' age and comorbidity influence adjuvant chemotherapy recommendations and whether physician or practice characteristics also affect these recommendations. METHODS: 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 III colon cancer who varied by age (55 v 80 years) and comorbid illness (none, moderate, severe congestive heart failure [CHF]). Repeated measures logistic regression was used to assess the influence of patient, physician, and practice characteristics on chemotherapy recommendations. RESULTS: Of 1,096 physicians, nearly all recommended chemotherapy for patients who were 55 years old with no comorbidity (99.0%), 55-years old with moderate CHF (88.6%), or 80 years old with no comorbidity (92.6%); many fewer recommended chemotherapy for 55-year-old patients with severe CHF (24.9%) or 80-year-old patients with moderate (47.2%) or severe (9.0%) CHF (P < .001). Younger physicians (P < .001) were more likely than others to recommend adjuvant chemotherapy overall, although physician factors explained little of the variability in recommendations. CONCLUSION: Physicians agree with guidelines recommending adjuvant chemotherapy for young, healthy patients with stage III colon cancer but 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.

Author information

Author/s: Keating, Nancy L (NL); Landrum, Mary Beth (MB); Klabunde, Carrie N (CN); Fletcher, Robert H (RH); Rogers, Selwyn O (SO); Doucette, William R (WR); Tisnado, Diana (D); Clauser, Steven (S); Kahn, Katherine L (KL);

Affiliation: Division of General Internal Medicine and the Department of Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, USA. keating(-atsign-)hcp.med.harvard.edu

Grants: U01 CA01013 (Agency:NCI NIH HHS) ; U01 CA093324 (Agency:NCI NIH HHS) ; U01 CA093326 (Agency:NCI NIH HHS) ; U01 CA093329 (Agency:NCI NIH HHS) ; U01 CA093332 (Agency:NCI NIH HHS) ; U01 CA093344 (Agency:NCI NIH HHS) ; U01 CA093348 (Agency:NCI NIH HHS) ; U01 CDA093344 (Agency:PHS HHS)

Journal and publication information

Publication Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.

Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol), published in United States. (Language: eng)

Reference: 2008-May; vol 26 (issue 15) : pp 2532-7

Dates: Created 2008/05/19; Completed 2008/06/17; Revised 2008/10/09;

PMID: 18487570, status: MEDLINE (last retrieved date: 2/18/2009)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: J Clin Oncol. 2008 Sep 20;26(27):4516-7; author reply 4517-8. (PMID: 18802167)

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