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• W2334334427 abstract "Background: As per Cancer Care Ontario (CCO) guidelines, it is advised that colorectal cancer (CRC) patients receive their first adjuvant chemotherapy (AC) by 8 weeks post surgical resection. However, a recent study suggests, that treatment should begin between 4 to 6 weeks post surgical resection in order to receive the greatest survival benefit. This retrospective study was performed at a single institution, Mount Sinai Hospital (MSH), to determine the treatment timelines and to elucidate any barriers to AC. Methods: 290 CRC patients received treatment between January 1, 2005 to April 30, 2012. 155 patients met the inclusion criteria by receiving both surgical resection and AC at MSH as well as having stage II or III disease. The data that was collected included patient demographics, date of surgery, date of referral, date of central line insertion, date of Medical Oncology consult, date of first AC, medical complications and recurrence status. Data was analyzed using statistical methods in Microsoft Excel, assuming p values <0.05 as significant. Results: The mean age of the patients was 59.6 years (range 23 – 83); 57% were male and 74% had stage III disease; 87% (114/155) had colon cancer and 75% of AC was the FOLFOX regimen. The mean time from surgery to first AC was 63.8 days (sd = 15.3) or 9.1 weeks (range 5.3-18.7). 77% of patients received first AC after the recommended CCO guideline of 8 weeks. The mean time of referral from the surgeon to medical oncology was 27.5 days (sd = 16.5). The mean time from medical oncology consult to first AC was 24.1 days (sd = 15.3) including 18.7 days waiting for port-a-cath insertion. Post-operative medical complications affected 26% of patients and were strongly correlated with a delay to first AC (p = 0.0399). Each part of the referral process was correlated with delay to AC. Analysis of recurrence in association to time to first AC revealed that no patients treated at 5 or 6 weeks recurred, where as 100% of patients who were treated at 16, 17 or 18 weeks recurred. The majority of patients were treated between 7 and 11 weeks and have a recurrence rate of 22%. While trends were identified, association between recurrence and delay was marginally related (p = 0.056). Only 21.9% of patients have recurred to date, with an average follow-up of 3.07 years (range 0.19 – 7.32). Factors such as stage (p = 0.16), site of disease (p = 0.19) AC regimen (p = 0.35) and gender (p = 0.68) were not found to be significant factors affecting delay to AC. Conclusion: Compliance to current CCO guidelines can be enhanced in CRC patients. This analysis was done to identify barriers along the multistep process patients undergo as they receive treatment of CRC. Barriers to timely AC treatment include presence of postoperative complications as well as a number of the stages of the referral process. While recurrence rates overall are low, a number of associations have been found. Analysis of pooled data is ongoing at hospitals in Southern Ontario to improve the timeliness of care and achieve greater consistency between hospitals." @default.
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• W2334334427 date "2013-06-01" @default.
• W2334334427 modified "2023-09-28" @default.
• W2334334427 title "Time From Surgery to First Adjuvant Chemotherapy: Single Canadian Institution Experience" @default.
• W2334334427 doi "https://doi.org/10.1093/annonc/mdt203.229" @default.
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