title: Factors associated with use of preoperative chemoradiation therapy for rectal cancer in the Cancer Care Outcomes Research and Surveillance Consortium.
abstract: OBJECTIVE
  Preoperative (preop) chemoradiation therapy (CRT) improves local control and reduces toxicity more than postoperative (postop) CRT for the treatment of stages II/III rectal cancer, but studies suggest that many patients still receive postop CRT. We examined patient beliefs and clinical and provider characteristics associated with receipt of recommended therapy.
  
  
  METHODS
  We identified stages II/III rectal cancer patients who had primary site resection and CRT among subjects in the Cancer Care Outcomes Research and Surveillance Consortium, a population-based and health system-based prospective cohort of newly diagnosed colorectal cancer patients from 2003 to 2005. Patient surveys and abstracted medical records were used to construct variables and determine sequence of CRT and surgery. Logistic regression was used to model the association between predictors and receipt of preop CRT.
  
  
  RESULTS
  Of the 201 patients, 66% received preop and 34% received postop CRT. Those visiting a medical oncologist and/or radiation oncologist before a surgeon had a 96% (95% confidence interval, 92%-100%) predicted probability of receiving preop CRT, compared with 48% (95% confidence interval, 41%-55%) for those visiting a surgeon first. Among those visiting a surgeon first, documentation of recommended staging procedures was associated with receiving preop CRT.
  
  
  CONCLUSIONS
  Sequence of provider visits and documentation of recommended staging procedures were important predictors of receiving preop CRT. Initial multidisciplinary evaluation led to better adherence to CRT guidelines. Further evaluation of provider characteristics, referral patterns, and related health system processes should be undertaken to inform targeted interventions to reduce variation from recommended care.
authors.affiliation: Departments of *Epidemiology §Biostatistics, University of Iowa College of Public Health †VA Office of Rural Health, Veterans Rural Health Resource Center-Central Region, Iowa City VA Health Care System ¶Department of Internal Medicine, Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa College of Medicine, Iowa City, IA ‡Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE ∥Department of Surgical Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Charlton
authors.forename: Chi
authors.initials: C
authors.lastname: Lin
authors.forename: Dingfeng
authors.initials: D
authors.lastname: Jiang
authors.forename: Karyn B
authors.initials: KB
authors.lastname: Stitzenberg
authors.forename: Thorvardur R
authors.initials: TR
authors.lastname: Halfdanarson
authors.forename: Jane F
authors.initials: JF
authors.lastname: Pendergast
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chrischilles
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wallace
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D000368:Aged; D059248:Chemoradiotherapy; D016001:Confidence Intervals; D003625:Data Collection; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010820:Physicians; D011184:Postoperative Period; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome