Chandhoke Gursimran, Wei Xuejiao, Nanji Sulaiman, Biagi James, Peng Yingwei, Krzyzanowska Monika, Mackillop William J, Booth Christopher M
Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada.
Department of Oncology, Queen's University, Kingston, Canada.
Ann Surg Oncol. 2016 Aug;23(8):2529-38. doi: 10.1245/s10434-016-5181-8. Epub 2016 Mar 10.
Reasons for variable utilization of adjuvant chemotherapy (ACT) for colon cancer have not been well described. We report medical oncology (MO) referral patterns and subsequent use of ACT.
Treatment records were linked to the population-based Ontario Cancer Registry to describe MO referral and ACT use among 5289 patients with stage II-III colon cancer treated in 2002-2008. Modified Poisson regression was used to analyze factors associated with MO referral and ACT use. Multilevel modeling was used to explore the proportion of variation in practice attributable to providers.
There was wide geographic variation in MO referral rates for stage II (range 37-80 %, p < 0.001) and stage III disease (range 77-98 %, p < 0.001). Use of ACT among referred patients varied across regions for stage II (range 12-49 %, p < 0.001) but not stage III (range 67-79 %, p = 0.353). For both stages, younger patients (p < 0.001) with less comorbidity (p < 0.010) were more likely to be referred to MO and treated with ACT. Applying the fitted regression model to nonreferred stage III patients suggests that 38 % had >50 % probability of having ACT if they had seen a MO. Among stage III patients, 15 % percent of the variance in MO referral rate and 6 % of the variance in ACT utilization rate is attributable to the surgeon and MO respectively.
A substantial proportion of non-referred patients with stage III colon cancer may have been offered ACT if they had seen MO. A small proportion of variance in referral rate and ACT treatment is attributable to providers.
结肠癌辅助化疗（ACT）使用情况存在差异的原因尚未得到充分描述。我们报告了肿瘤内科（MO）的转诊模式以及ACT的后续使用情况。
将治疗记录与基于人群的安大略癌症登记处相链接，以描述2002 - 2008年接受治疗的5289例II - III期结肠癌患者中MO转诊和ACT使用情况。采用修正泊松回归分析与MO转诊和ACT使用相关的因素。使用多水平模型探讨实践中因医疗服务提供者导致的变异比例。
II期（范围37 - 80%，p < 0.001）和III期疾病（范围77 - 98%，p < 0.001）的MO转诊率存在广泛的地域差异。II期转诊患者中ACT的使用在各地区有所不同（范围12 - 49%，p < 0.001），但III期无差异（范围67 - 79%，p = 0.353）。对于两个阶段，年龄较小（p < 0.001）且合并症较少（p < 0.010）的患者更有可能被转诊至MO并接受ACT治疗。将拟合的回归模型应用于未转诊的III期患者表明，如果他们看过肿瘤内科医生，38%的患者接受ACT的概率>50%。在III期患者中，MO转诊率差异的15%和ACT使用率差异的6%分别归因于外科医生和肿瘤内科医生。
相当一部分未转诊的III期结肠癌患者如果看过肿瘤内科医生可能会接受ACT治疗。转诊率和ACT治疗差异的一小部分归因于医疗服务提供者。
