Use of Adjuvant Chemotherapy and Radiation Therapy for Colorectal Cancer in a Population-Based Cohort
Abstract
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 II 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 or= 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 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 monitorin…
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The difference between a moderately above-average and a moderately below-average hospital was about as large as the effect of the most important patient characteristic in the model.
“the difference between a moderately above-average and a moderately below-average hospital (1 SD above or below average) was about as large as the effect of the most important patient characteristic identified in the model.”
From Analysis of variance—why it is more important than ever (2005) · cites this paper as Ayanian et al. (2003)
An analysis of predictors of chemotherapy administration for colorectal cancer estimated a residual variance component for hospital effects after controlling for measured hospital and patient characteristics.
“An analysis of predictors of administration of clinically appropriate chemotherapy for colorectal cancer estimated a residual variance component for hospital effects, after controlling for measured hospital and patient characteristics [Ayanian et al. (2003)].”
From Analysis of variance—why it is more important than ever (2005) · cites this paper as Ayanian et al. (2003)
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References 48 · Cited by 308
- Authors
- Ayanian, J. Z., Zaslavsky, A. M., Fuchs, C. S., Guadagnoli, E., Creech, C. M., Cress, R. D., O’Connor, L. C., West, D. W., Allen, M. E., Wolf, R. E., & Wright, W. E.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Journal of Clinical Oncology
- Published
- 2003-04-01
- Volume
- 21
- Issue
- 7
- Pages
- 1293-1300
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2129309727
- Cited by
- 308
- References
- 48
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 6 · 2022: 7 · 2021: 5 · 2020: 6 · 2019: 11 · 2018: 6 · 2017: 7 · 2016: 13 · 2015: 12 · 2014: 17 · 2013: 21 · 2012: 23
- FWCI
- 10.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Health and Human Services
- Agency for Healthcare Research and Quality (R01HS09869)
- 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
- adjuvant chemotherapy, adjuvant radiotherapy, colorectal cancer, stage III colon cancer, stage II/III rectal cancer, treatment utilization, health disparities, hospital volume, racial disparities, age differences, marital status, patient refusal, comorbidities, quality of cancer care, California Cancer Registry
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, California, Female, Hospitals, Humans, Male, Middle Aged, Neoplasm Staging, Patient Acceptance of Health Care, Registries, Colorectal Neoplasms, Cohort Studies, Comorbidity, Chemotherapy, Adjuvant, Marital Status, Radiotherapy, Adjuvant
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