Treatment and referral patterns for colorectal cancer.
BACKGROUND
National guidelines recommend adjuvant chemotherapy for colorectal cancer stages III, and IV; however, it has been shown that only 45-55% of these patients receive chemotherapy.


OBJECTIVE
We sought to describe treatment patterns for patients diagnosed with colorectal cancer and to examine the reasons why patients do not receive chemotherapy.


METHODS
This was a retrospective cohort study.


METHODS
Patients included newly diagnosed cases of colorectal cancer at a health maintenance organization in central Massachusetts between January 1, 1997, and June 30, 1999.


METHODS
The main outcome measure was a referral or visit to an oncologist.


RESULTS
Sixty-six percent (n=143) of the 217 colorectal cancer cases had a referral/visit to an oncologist or evidence of chemotherapy within 4 months of the index date. The referral rates by stage were: stage I, 47.7%; stage II, 59.5%; stage III, 87.1%; and stage IV, 66.7%. Of patients not referred with stage III disease, 4/8 were not referred because the treating physician did not recommend an oncology referral; patient refusal accounted for 3/8 (37.5%). The most commonly cited reason for lack of referral for stage IV patients was existing comorbidities or death. Younger age (<70 years) and stage III at diagnosis were significant predictors of oncology referral/visit.


CONCLUSIONS
A substantial proportion of colorectal cancer patients are receiving appropriate referral for chemotherapy. This study is the first to elucidate reasons why patients do not receive chemotherapy and highlights both patient and physician factors.
Galt Associates, Inc., Sterling, Virginia, USA. oliveri1@mskcc.org
Susan A
SA
Oliveria
Marianne Ulcickas
MU
Yood
Ulka B
UB
Campbell
Steven M
SM
Yood
Paul
P
Stang
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies
D000970:Antineoplastic Agents