title: Complicated postoperative recovery increases omission, delay and discontinuation of adjuvant chemotherapy in patients with Stage III colon cancer.
abstract: OBJECTIVE
  The study included investigation of factors determining suboptimal adjuvant chemotherapy of patients diagnosed with Stage III colon cancer.
  
  
  METHODS
  All 606 patients diagnosed with Stage III colon cancer between 2006 and 2008 in the western part of the Netherlands were included. Patient [gender, age, comorbidity and socio-economic status (SES)], tumour (location, stage and grade) and treatment (emergency surgery, laparoscopic surgery, reoperation, hospital stay and multidisciplinary meeting) factors were examined in logistic regression analyses predicting a complicated postoperative period and omission, delay and discontinuation of adjuvant chemotherapy.
  
  
  RESULTS
  Overall, 27% of all patients experienced a complicated postoperative period, which was independently associated with emergency surgery, older age, multiple comorbidity, male gender and poor tumour grade. Of patients who survived this period, 60% received chemotherapy. Chemotherapy was omitted more often in women, the elderly and in patients with Stage IIIB, reoperation, prolonged hospital stay and (borderline) after open surgery. Of patients who received chemotherapy, 86% started within 8 weeks after surgery. Patients with a higher SES, reoperation and prolonged hospital stay had a higher probability of a delayed start. Sixty-seven per cent of patients completed their chemotherapy. For women, elderly patients and patients with prolonged hospital stay a higher probability of discontinuation was noted.
  
  
  CONCLUSIONS
  Age was the most important predictive factor for receiving adjuvant chemotherapy. However, at all ages, complicated postoperative recovery negatively influenced the administration of chemotherapy to Stage III colon cancer patients, as well as a timely start and completion of chemotherapy.
authors.affiliation: Comprehensive Cancer Centre The Netherlands (CCCNL), Utrecht, The Netherlands.
authors.forename: L G M
authors.initials: LG
authors.lastname: van der Geest
authors.forename: J E A
authors.initials: JE
authors.lastname: Portielje
authors.forename: M W J M
authors.initials: MW
authors.lastname: Wouters
authors.forename: N I
authors.initials: NI
authors.lastname: Weijl
authors.forename: B C
authors.initials: BC
authors.lastname: Tanis
authors.forename: R A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.forename: H
authors.initials: H
authors.lastname: Struikmans
authors.forename: J W R
authors.initials: JW
authors.lastname: Nortier
mesh_terms: D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D004630:Emergencies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012086:Reoperation; D012737:Sex Factors; D012923:Social Class; D013997:Time Factors; D028761:Withholding Treatment
chemical_list: D000970:Antineoplastic Agents
keywords: Colon cancer; Stage III; adjuvant chemotherapy; delay; discontinuation; postoperative recovery