Adjuvant chemotherapy for stage II colon cancer: influence of care structures' characteristics on a controversial clinical practice.
BACKGROUND
Adjuvant chemotherapy for stage II colon cancer is a controversial practice and is not recommended by the French Consensus Conference outside of therapeutic trial.


OBJECTIVE
To assess, within a well-defined population, the influence of hospital characteristics in this practice.


METHODS
In the Rhône-Alpes region (10% of the French population), 534 patients presenting with colon cancer stage II were operated on in 81 hospitals in the year 2000. The influence of hospital characteristics on the use of adjuvant chemotherapy was assessed using a multivariate logistic regression.


RESULTS
Overall, 19.5% of patients received adjuvant chemotherapy. Younger age, T4 tumour, hospital volume lower than 20 colon cancer surgeries [odds ratio (OR) 2.96; P<0.001], formal multidisciplinary input with specific written account (OR 3.25; P=0.001), private funding of the hospital (OR 1.82; P=0.019), and clinical complications at diagnosis were independently associated with higher rates of chemotherapy. On the other hand, a number of examined lymph nodes lower than recommendations did not have any influence on chemotherapy use.


CONCLUSIONS
Hospital characteristics had independently influenced the practice of adjuvant chemotherapy in stage II colon cancer. The more important institutional factor was the hospital procedure volume. The decisions of the multidisciplinary committees appeared at times paradoxical; a more comprehensive evaluation of this practice is needed.
CNAMTS Medical Service, Grenoble, University hospital of Grenoble, Grenoble, France.
Eléonore
E
Alter
Jean-Marc
JM
Phelip
Jean-Noel
JN
Guilhot
Michel
M
Matysiak
Michel
M
Vermorel
Xavier
X
Roblin
D000367:Age Factors; D000368:Aged; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005602:France; D016304:Hospitals, Private; D006801:Humans; D007415:Intestinal Obstruction / Q000188:drug therapy / Q000601:surgery; D016015:Logistic Models; D008297:Male; D009367:Neoplasm Staging; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000592:standards*; D016896:Treatment Outcome