Receipt of recommended therapy by patients with advanced colorectal cancer

To evaluate utilization of surgery, chemotherapy, and radiation therapy among patients with stage II or III colon cancer and stage II/III rectal or rectosigmoid cancer, as recommended by current national guidelines.

This cross-sectional study at the Michael E. DeBakey Veterans Affairs Medical Center (Houston, TX) used 1999-2003 administrative data to identify patients with a diagnostic code for colorectal cancer. Medical charts were then abstracted to identify an incident cohort with stage II or III cancer. Outcome of interest was receipt of recommended therapy defined as surgery only (stage II colon) or surgery with adjuvant chemo- or radiotherapy (stage III colon or stage II/III rectal/rectosigmoid cancer). Potential determinants of receipt of recommended therapy were analyzed using logistic regression.

Among 197 incident cases diagnosed or treated, mean age of patients was 66 yr (SD, 11 yr), 64% were Caucasian, and 98.5% were men. A gastroenterologist diagnosed 72.5% tumors including 62 stage II colon, 62 stage III colon, and 73 stage II/III rectal cancers. Referral to oncology occurred in 76% of stage II colon, 92% of stage III colon, and 99% of rectal cancers. 87% of stage II and 71% of stage III colon cancer patients received recommended therapy, compared to only 42.5% of rectal cancer patients. Predictors of receipt of recommended therapy among rectal cancers included being married (OR, 5.3; 95% CI: 1.6-17.1), presentation at tumor board (OR, 3.6; 95% CI: 1.2-11.2), or age<65 yr (OR, 3.5; 95% CI: 1.3-9.3). When patient's comorbidity and physician's decision-making process were considered in the assessment of the outcome, only presentation at tumor board remained predictive of receipt of recommended therapy.

Most colon cancer patients at a major VA medical center receive recommended therapy. Among rectal cancer patients, those presented at tumor board are most likely to receive recommended therapy.