Department of Surgery, University of Kentucky Medical Center, Lexington, KY; Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY.
Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY.
J Am Coll Surg. 2020 Apr;230(4):428-439. doi: 10.1016/j.jamcollsurg.2019.12.041. Epub 2020 Feb 13.
Kentucky has one of the highest mortality rates for colon cancer, despite dramatic improvements in screening. The National Comprehensive Cancer Network (NCCN) guidelines recommend operation and adjuvant chemotherapy for locally advanced (stage IIb/c and stage III) colon cancer (LACC). The purpose of this study was to determine the rate of nonadherence with current standard of care (SOC) and associated factors as possible contributors to mortality.
The Kentucky Cancer Registry database linked with administrative health claims was queried for individuals (20 years and older) diagnosed with LACC from 2007 to 2012. Bivariate and logistic regression of nonadherence was performed. Survival analysis was performed with Cox regression and Kaplan-Meier plots.
A total of 1,404 patients with LACC were included. Approximately 42% of patients with LACC were noted to be nonadherent to SOC, with nearly all (95.7%) failing to receive adjuvant chemotherapy. After adjusting for all significant factors, we found the factors associated with nonadherence included the following: age older than 75 years, stage III colon cancer, high Charlson Comorbidity Index (3+), low poverty level, Medicaid coverage, and disability. Adherence to SOC is associated with a significant improvement in the 5-year survival rate compared with nonadherence (63.0% and 27.4%, respectively; p < 0.0001).
Our study identified multiple factors associated with the failure of patients with LACC to receive SOC, particularly adjuvant chemotherapy, suggesting the need to focus on improving adjuvant chemotherapy compliance in specific populations. Nonadherence to LACC SOC is likely a major contributor to the persistently high mortality rates in Kentucky.
尽管筛查有了显著改善，但肯塔基州的结肠癌死亡率仍然位居全美前列。美国国家综合癌症网络（NCCN）指南建议对局部晚期（IIb/c 期和 III 期）结肠癌（LACC）进行手术和辅助化疗。本研究旨在确定不遵守当前标准治疗（SOC）的比率以及相关因素，这些因素可能是导致死亡率升高的原因。
从 2007 年至 2012 年，通过肯塔基州癌症登记数据库与行政健康索赔进行了查询，以确定患有 LACC 的个体（20 岁及以上）。对不遵守 SOC 的情况进行了单变量和逻辑回归分析。采用 Cox 回归和 Kaplan-Meier 图进行生存分析。
共纳入 1404 例 LACC 患者。大约 42%的 LACC 患者被认为不遵守 SOC，几乎所有患者（95.7%）都未接受辅助化疗。在调整了所有显著因素后，我们发现与不遵守 SOC 相关的因素包括：年龄大于 75 岁、III 期结肠癌、高 Charlson 合并症指数（3+）、低贫困水平、医疗补助覆盖范围和残疾。与不遵守 SOC 相比，SOC 的依从性与 5 年生存率的显著提高相关（分别为 63.0%和 27.4%；p<0.0001）。
我们的研究确定了多个与 LACC 患者未能接受 SOC（尤其是辅助化疗）相关的因素，这表明需要关注提高特定人群的辅助化疗依从性。不遵守 LACC SOC 可能是肯塔基州持续高死亡率的主要原因之一。
