title: Characteristics of patients with stage III colon adenocarcinoma who fail to receive guideline-recommended treatment.
abstract: BACKGROUND
  Many patients with stage III colon adenocarcinoma do not receive adjuvant chemotherapy despite the proven survival advantage it offers. To enhance the provision of optimal cancer care, patient characteristics associated with not receiving guideline-adherent treatment must be identified among patients with operable, stage III colon adenocarcinoma.
  
  
  METHODS
  This was a population-based, retrospective study of all patients who underwent surgery for stage III colon adenocarcinoma diagnosed from 2002 through 2005 in Alberta, Canada. Demographic and treatment information captured in the Alberta Cancer Registry were linked to: 1) hospital discharge data to determine comorbidities, 2) electronic medical records to identify consults with oncologists, and 3) the 2001 Canadian census for neighborhood-level socioeconomic data. Multivariate log-binomial regression models were used to identify patient characteristics that were associated with not having a consultation with a medical oncologist and not receiving adjuvant chemotherapy.
  
  
  RESULTS
  Of the 772 patients who underwent surgery for stage III colon adenocarcinoma and met the eligibility criteria, 618 patients (80%) had a consultation with an oncologist. Of those, 388 patients (63%) initiated adjuvant chemotherapy within 84 days of their surgery. Patient characteristics that were associated with not having a consultation with an oncologist were neighborhood income, geography, age, and comorbidities. Of those patients who had a consultation, after adjusting for comorbidities, only older age was related to not receiving adjuvant chemotherapy.
  
  
  CONCLUSIONS
  The current results indicated that the proportion of patients with stage III colon adenocarcinoma who did not receive treatment according to evidence-based guidelines was appreciable. The authors concluded that the association of this failure with patient age, geography, and income is concerning and that evaluation of referral patterns and interventions are needed.
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada. marcy.winget@albertahealthservices.ca
authors.forename: Marcy
authors.initials: M
authors.lastname: Winget
authors.forename: Shakhawat
authors.initials: S
authors.lastname: Hossain
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: Andrew
authors.initials: A
authors.lastname: Scarfe
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000368:Aged; D000416:Alberta; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D012111:Residence Characteristics; D012307:Risk Factors; D012959:Socioeconomic Factors