title: Less-than-standard treatment in rectal cancer patients: which patients are at risk?
abstract: OBJECTIVE
  Guidelines recommend that patients with nonmetastatic rectal cancer receive surgery and adjuvant chemotherapy and/or radiation therapy (XRT) after surgery (especially if stage II and III). Studies reported that 90% of stage II and III patients received surgery, and 70% received adjuvant treatment. In states where socioeconomics and limited medical resources may hinder treatment, cancer care is understudied. The objective is to describe initiation and completion of rectal cancer treatment in Alabama.
  
  
  METHODS
  Medicare claims were obtained for 675 stage I to III rectal cancer patients diagnosed in 1999-2003, enrolled in fee-for-service Medicare, and with at least 9 months of followup. Logistic regressions were used to identify significant differences by sex, age, and race in the likelihood of initiating treatment and receiving an incomplete course of chemotherapy or XRT (< or = 120 days of chemotherapy and < or = 28 days of XRT).
  
  
  RESULTS
  Overall, 90% received surgery, of which 43% received some adjuvant treatment. Among stage II to III patients, 58.8% received adjuvant treatment. Except for patients aged 75 years and greater being less likely to start chemotherapy, there were no significant differences in initiation by age, sex, and race. Depending on concurrent administration of chemotherapy and XRT, 29% to 35% received incomplete chemotherapy, and 16% to 23% incomplete XRT. Women were more likely to have incomplete chemotherapy than men.
  
  
  CONCLUSIONS
  Adjuvant treatment was less than reported in previous studies. Treatment initiation and completion did not differ across demographic factors. Future studies should explore reasons why older rectal cancer patients in Alabama are less likely to receive recommended treatment.
authors.affiliation: Department of Medicine/Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-4410, USA. mpisu@uab.edu
authors.forename: Maria
authors.initials: M
authors.lastname: Pisu
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Richardson
authors.forename: Young-Il
authors.initials: YI
authors.lastname: Kim
authors.forename: Helen
authors.initials: H
authors.lastname: Krontiras
authors.forename: Michelle Y
authors.initials: MY
authors.lastname: Martin
authors.forename: Maribel
authors.initials: M
authors.lastname: Salas
authors.forename: Lori A
authors.initials: LA
authors.lastname: Pollack
mesh_terms: D000368:Aged; D000407:Alabama; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology*; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000208:ethnology / Q000628:therapy*; D012042:Registries; D012737:Sex Factors; D014481:United States