The impact of delayed commencement of adjuvant chemotherapy (eight or more weeks) on survival in stage II and III colon cancer: A national population-based cohort study

YoungWan Kim, Eun Hee Choi, Bo Ra Kim, Woo Ah Ko, Yeong Mee Do, Ikyong Kim

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Abstract

Background: To examine the impact of chemotherapy delay on survival in patients with stage II or III colon cancer and the factors associated with the delay (=8 weeks) of adjuvant chemotherapy. Methods: Patients undergoing curative resection and adjuvant chemotherapy in a national population-based cohort were included. Results: Among 5355 patients, 154 (2.9%) received chemotherapy more than 8 weeks after surgery. Based on a multivariate analysis, the risk factors associated with chemotherapy delay ≥8 weeks were older age [65 to 74 years (hazard ratio [HR]=1.48) and ≥75 years (HR=1.69), p=0.0354], medical aid status in the health security system (HR=1.76, p=0.0345), and emergency surgery (HR=2.43, p=0.0002). Using an 8-week cutoff, the 3-year overall survival rate was 89.62% and 80.98% in the < 8 weeks and ≥8 weeks groups, respectively (p=0.008). Independent prognostic factors for inferior overall survival included chemotherapy delay ≥8 weeks (HR=1.49, p=0.0365), older age [65 to 74 years (HR=1.94) and ≥75 years (HR=3.41), p < 0.0001], TNM stage III (HR=2.46, p<0.0001), emergency surgery (HR=1.89, p < 0.0001), American Society of Anesthesiologists score of 3 or higher (HR=1.50, p < 0.0001), and higher transfusion amounts (HR=1.09, p=0.0392). Conclusions: This study shows that delayed commencement of adjuvant chemotherapy, defined as ≥ 8 weeks, is associated with inferior overall survival in colon cancer patients with stage II or III disease. The delay to initiation of adjuvant chemotherapy is influenced by several multidimensional factors, including patient factors (older age), insurance status (medical aid), and treatment-related factors (emergency surgery).

Original languageEnglish
Pages (from-to)80061-80072
Number of pages12
JournalOncotarget
Volume8
Issue number45
DOIs
Publication statusPublished - 2017 Jan 1

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Adjuvant Chemotherapy
Colonic Neoplasms
Cohort Studies
Survival
Drug Therapy
Emergencies
Population
Insurance Coverage
Age Factors
Health Status
Multivariate Analysis
Survival Rate
Therapeutics

All Science Journal Classification (ASJC) codes

  • Oncology

Cite this

@article{289067cccda14cf4865c8fde94f610c4,
title = "The impact of delayed commencement of adjuvant chemotherapy (eight or more weeks) on survival in stage II and III colon cancer: A national population-based cohort study",
abstract = "Background: To examine the impact of chemotherapy delay on survival in patients with stage II or III colon cancer and the factors associated with the delay (=8 weeks) of adjuvant chemotherapy. Methods: Patients undergoing curative resection and adjuvant chemotherapy in a national population-based cohort were included. Results: Among 5355 patients, 154 (2.9{\%}) received chemotherapy more than 8 weeks after surgery. Based on a multivariate analysis, the risk factors associated with chemotherapy delay ≥8 weeks were older age [65 to 74 years (hazard ratio [HR]=1.48) and ≥75 years (HR=1.69), p=0.0354], medical aid status in the health security system (HR=1.76, p=0.0345), and emergency surgery (HR=2.43, p=0.0002). Using an 8-week cutoff, the 3-year overall survival rate was 89.62{\%} and 80.98{\%} in the < 8 weeks and ≥8 weeks groups, respectively (p=0.008). Independent prognostic factors for inferior overall survival included chemotherapy delay ≥8 weeks (HR=1.49, p=0.0365), older age [65 to 74 years (HR=1.94) and ≥75 years (HR=3.41), p < 0.0001], TNM stage III (HR=2.46, p<0.0001), emergency surgery (HR=1.89, p < 0.0001), American Society of Anesthesiologists score of 3 or higher (HR=1.50, p < 0.0001), and higher transfusion amounts (HR=1.09, p=0.0392). Conclusions: This study shows that delayed commencement of adjuvant chemotherapy, defined as ≥ 8 weeks, is associated with inferior overall survival in colon cancer patients with stage II or III disease. The delay to initiation of adjuvant chemotherapy is influenced by several multidimensional factors, including patient factors (older age), insurance status (medical aid), and treatment-related factors (emergency surgery).",
author = "YoungWan Kim and Choi, {Eun Hee} and Kim, {Bo Ra} and Ko, {Woo Ah} and Do, {Yeong Mee} and Ikyong Kim",
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The impact of delayed commencement of adjuvant chemotherapy (eight or more weeks) on survival in stage II and III colon cancer : A national population-based cohort study. / Kim, YoungWan; Choi, Eun Hee; Kim, Bo Ra; Ko, Woo Ah; Do, Yeong Mee; Kim, Ikyong.

In: Oncotarget, Vol. 8, No. 45, 01.01.2017, p. 80061-80072.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The impact of delayed commencement of adjuvant chemotherapy (eight or more weeks) on survival in stage II and III colon cancer

T2 - A national population-based cohort study

AU - Kim, YoungWan

AU - Choi, Eun Hee

AU - Kim, Bo Ra

AU - Ko, Woo Ah

AU - Do, Yeong Mee

AU - Kim, Ikyong

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: To examine the impact of chemotherapy delay on survival in patients with stage II or III colon cancer and the factors associated with the delay (=8 weeks) of adjuvant chemotherapy. Methods: Patients undergoing curative resection and adjuvant chemotherapy in a national population-based cohort were included. Results: Among 5355 patients, 154 (2.9%) received chemotherapy more than 8 weeks after surgery. Based on a multivariate analysis, the risk factors associated with chemotherapy delay ≥8 weeks were older age [65 to 74 years (hazard ratio [HR]=1.48) and ≥75 years (HR=1.69), p=0.0354], medical aid status in the health security system (HR=1.76, p=0.0345), and emergency surgery (HR=2.43, p=0.0002). Using an 8-week cutoff, the 3-year overall survival rate was 89.62% and 80.98% in the < 8 weeks and ≥8 weeks groups, respectively (p=0.008). Independent prognostic factors for inferior overall survival included chemotherapy delay ≥8 weeks (HR=1.49, p=0.0365), older age [65 to 74 years (HR=1.94) and ≥75 years (HR=3.41), p < 0.0001], TNM stage III (HR=2.46, p<0.0001), emergency surgery (HR=1.89, p < 0.0001), American Society of Anesthesiologists score of 3 or higher (HR=1.50, p < 0.0001), and higher transfusion amounts (HR=1.09, p=0.0392). Conclusions: This study shows that delayed commencement of adjuvant chemotherapy, defined as ≥ 8 weeks, is associated with inferior overall survival in colon cancer patients with stage II or III disease. The delay to initiation of adjuvant chemotherapy is influenced by several multidimensional factors, including patient factors (older age), insurance status (medical aid), and treatment-related factors (emergency surgery).

AB - Background: To examine the impact of chemotherapy delay on survival in patients with stage II or III colon cancer and the factors associated with the delay (=8 weeks) of adjuvant chemotherapy. Methods: Patients undergoing curative resection and adjuvant chemotherapy in a national population-based cohort were included. Results: Among 5355 patients, 154 (2.9%) received chemotherapy more than 8 weeks after surgery. Based on a multivariate analysis, the risk factors associated with chemotherapy delay ≥8 weeks were older age [65 to 74 years (hazard ratio [HR]=1.48) and ≥75 years (HR=1.69), p=0.0354], medical aid status in the health security system (HR=1.76, p=0.0345), and emergency surgery (HR=2.43, p=0.0002). Using an 8-week cutoff, the 3-year overall survival rate was 89.62% and 80.98% in the < 8 weeks and ≥8 weeks groups, respectively (p=0.008). Independent prognostic factors for inferior overall survival included chemotherapy delay ≥8 weeks (HR=1.49, p=0.0365), older age [65 to 74 years (HR=1.94) and ≥75 years (HR=3.41), p < 0.0001], TNM stage III (HR=2.46, p<0.0001), emergency surgery (HR=1.89, p < 0.0001), American Society of Anesthesiologists score of 3 or higher (HR=1.50, p < 0.0001), and higher transfusion amounts (HR=1.09, p=0.0392). Conclusions: This study shows that delayed commencement of adjuvant chemotherapy, defined as ≥ 8 weeks, is associated with inferior overall survival in colon cancer patients with stage II or III disease. The delay to initiation of adjuvant chemotherapy is influenced by several multidimensional factors, including patient factors (older age), insurance status (medical aid), and treatment-related factors (emergency surgery).

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U2 - 10.18632/oncotarget.17767

DO - 10.18632/oncotarget.17767

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