Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Division of Medical Oncology, Sinai Health System, Mount Sinai Hospital, Toronto, Canada.
Clin Colorectal Cancer. 2023 Dec;22(4):431-441.e9. doi: 10.1016/j.clcc.2023.08.003. Epub 2023 Aug 7.
The International Duration Evaluation of Adjuvant Therapy (IDEA) collaboration in 2017 established 3 months of adjuvant therapy as an alternative to 6 months of therapy for stage III colon cancer. We determined the association between the IDEA publication, changes in clinical practice, and prescriber variation.
Using linked databases, we identified Ontarians aged ≥18 years at diagnosis of stage III colon cancer between 2007 and 2019 who received oxaliplatin-containing adjuvant therapy. The outcome was duration of therapy, categorized as ≤25%, >25% to ≤50%, >50% to ≤75%, and >75% of a 6-month course of therapy to approximate treatment durations in the IDEA collaboration. We examined trends in duration over time using an interrupted time series regression model. We analyzed treatment duration after accounting for patient and prescriber characteristics, using multivariable mixed effects logistic regression models to quantify between-prescriber variation.
We included 4695 patients with stage III colon cancer who received oxaliplatin-containing adjuvant chemotherapy, of whom 77.5% initiated treatment pre-IDEA and 22.5% initiated treatment post-IDEA. Post-IDEA, there was a 16.4% (95% CI, 12.5%-20.3%) absolute increase in the proportion of patients treated with ≤50% of a maximal course of therapy. This trend was greatest among patients with low-risk tumors. Prescriber variation increased pre-IDEA to 15.6% post-IDEA (variance partition coefficient 5.4% pre-IDEA and 15.6% post-IDEA).
The publication of IDEA was associated with increases in short duration adjuvant therapy and prescriber-level practice variation for stage III colon cancer. Clinicians should be better supported to make consistent recommendations about adjuvant duration under conditions of uncertainty and trade-offs.
2017 年，国际辅助治疗持续时间评估（IDEA）合作组织将辅助治疗 3 个月确立为 III 期结肠癌 6 个月治疗的替代方案。我们确定了 IDEA 出版物、临床实践变化和处方者差异之间的关联。
我们使用链接数据库，确定了 2007 年至 2019 年期间被诊断为 III 期结肠癌且年龄≥18 岁的安大略省居民，他们接受了含奥沙利铂的辅助治疗。结果是治疗持续时间，分为≤25%、>25%至≤50%、>50%至≤75%和>75%的 6 个月疗程，以近似 IDEA 合作组织中的治疗持续时间。我们使用中断时间序列回归模型检查随时间的趋势。我们在考虑患者和处方者特征后分析了治疗持续时间，使用多变量混合效应逻辑回归模型量化了处方者之间的差异。
我们纳入了 4695 名接受含奥沙利铂辅助化疗的 III 期结肠癌患者，其中 77.5%在 IDEA 之前开始治疗，22.5%在 IDEA 之后开始治疗。IDEA 之后，接受≤50%最大疗程治疗的患者比例绝对增加了 16.4%（95%CI，12.5%-20.3%）。这一趋势在低危肿瘤患者中最大。处方者差异从 IDEA 之前的 15.6%增加到 IDEA 之后的 15.6%（方差分解系数 IDEA 之前为 5.4%，IDEA 之后为 15.6%）。
IDEA 的发表与 III 期结肠癌短期辅助治疗的增加和处方者水平实践差异相关。在存在不确定性和权衡的情况下，临床医生应该得到更好的支持，以便就辅助治疗持续时间做出一致的建议。
