Completion of therapy by Medicare patients with stage III colon cancer
Open accessAbstract
BACKGROUND: Certain factors, such as race or age, are known to be associated with variation in initiation of adjuvant chemotherapy for stage III colon cancer, but little is known about what factors are associated with completion of adjuvant therapy. To determine whether predictors of initiation also predict completion, we analyzed Surveillance, Epidemiology, and End Results (SEER) program data linked to Medicare claims. We investigated mortality as a means to testing the validity of the completion measure that we created. METHODS: We studied 3193 stage III colon cancer patients whose diagnosis was recorded in 1992-1996 SEER program data linked to 1991-1998 Medicare claims and who initiated adjuvant chemotherapy after colon cancer resection. We defined a measure of adjuvant chemotherapy completion as one chemotherapy administration claim in a month. We tested the validity of the created measure and its relation to 3-year cancer mortality adjusted for demographic, clinical, and environmental variables. We explored the association of patient characteristics and treating physician characteristics with chemotherapy completion by use of multivariable logistic regression modeling. RESULTS: Of the 3193 patients, 2497 (78.2%) completed the course. Risk of cancer-related mortality was statistically significantly lower among those completing chemotherapy (relative risk = 0.79, 95% confidence interval = 0.69 to 0.89) than those with no adjuvant therapy. Patients who were female, widowed, increasingly elderly, rehospitalized, and living in certain regions were less likely to complete adjuvant chemotherapy than other patients. Race and other clinical, environmental, and physician characteristics were not associated with completion of therapy. CONCLUSIONS: Factors associated with incomplete adjuvant chemotherapy may represent physical frailty, treatment complications, and lack of social and psychological support. Interventions to mitigate these influences are a logical next step toward increasing chemotherapy completion rates.
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Lung and gastrointestinal cancers have poor prognosis and high symptom burden.
“especially lung and gastrointestinal cancers which have a poor prognosis and high symptom profile (12, 13).”
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- Authors
- Dobie, S. A., Baldwin, L.-M., Dominitz, J. A., Matthews, B., Billingsley, K., & Barlow, W.
- Affiliations
- Oregon Health & Science University (US)
- Corresponding author
- Dobie, Sharon A.
- Venue
- JNCI: Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-05-03
- Volume
- 98
- Issue
- 9
- Pages
- 610-619
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- PMC
- PMC3124351
- OpenAlex
- W2108822192
- Cited by
- 150
- References
- 53
- Citations by year
- 2026: 2 · 2024: 5 · 2023: 5 · 2022: 8 · 2021: 9 · 2020: 5 · 2019: 5 · 2018: 6 · 2017: 8 · 2016: 8 · 2015: 8 · 2014: 13 · 2013: 11 · 2012: 11
- FWCI
- 5.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (R01CA089544)
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
- Health Sciences › Medicine › Oncology › Colorectal Cancer Treatments and Studies
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Keywords
- stage III colon cancer, adjuvant chemotherapy, chemotherapy completion, Medicare beneficiaries, cancer mortality, predictors of treatment completion, patient characteristics, physician characteristics, SEER, Medicare claims data
- MeSH terms
- Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols, Colonic Neoplasms, Female, Medicare, Humans, Male, Neoplasm Staging, Patient Compliance, Predictive Value of Tests, Risk Factors, Social Support, United States, Reproducibility of Results, Logistic Models, Frail Elderly, Chemotherapy, Adjuvant, SEER Program
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