title: Timeliness of adjuvant chemotherapy for stage III adenocarcinoma of the colon: a measure of quality of care.
abstract: BACKGROUND
  Findings from multiple clinical trials established AC as a standard of care for stage III colon cancer. However, there is no recommended standard time for delivery of AC. We explored the timeliness of AC with FOLFOX as a predictor of recurrence and its role as a quality indicator in patients with stage III colon cancer.
  
  
  METHODS
  We conducted a retrospective analysis of patients with colon cancer who received AC at Los Angeles County Hospital and Norris Cancer Center between 2003 and 2011. Time to recurrence (TTR) was the primary end point of the study, Kaplan-Meier curves and log-rank tests were used to assess the association between timing of the AC and TTR.
  
  
  RESULTS
  We identified 102 patients with stage III colon cancer who had received AC. With a median follow-up of 3.2 years, time from surgery to AC was not a predictor of recurrence (P = .19). However, there was a nonsignificant trend toward higher risk of systemic recurrence when the delay of AC was more than 12 weeks (P = .068). Additionally, a significant association was found between age, race, type of hospital, and timeliness of AC.
  
  
  CONCLUSIONS
  To date, our study is the largest data set to assess the timeliness of FOLFOX as a predictor of outcome in stage III colon cancer. Because FOLFOX is the current standard for AC for colon cancer, we report a trend toward worse outcome when FOLFOX is delayed more than 12 weeks. This result, thus supports quality measures to assess the timeliness of AC in stage III colon cancer and might have a meaningful effect on the care of patients with colon cancer.
authors.affiliation: University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA.
authors.forename: Steven
authors.initials: S
authors.lastname: Yu
authors.forename: Maryam
authors.initials: M
authors.lastname: Shabihkhani
authors.forename: Dongyun
authors.initials: D
authors.lastname: Yang
authors.forename: Eddie
authors.initials: E
authors.lastname: Thara
authors.forename: Anthony
authors.initials: A
authors.lastname: Senagore
authors.forename: Heinz-Josef
authors.initials: HJ
authors.lastname: Lenz
authors.forename: Sarmad
authors.initials: S
authors.lastname: Sadeghi
authors.forename: Afsaneh
authors.initials: A
authors.lastname: Barzi
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D009944:Organoplatinum Compounds; D002955:Leucovorin; D005472:Fluorouracil
keywords: Adjuvant therapy; Affordable Care Act; Colon cancer; Quality measure; Racial disparities