title: The impact of delayed chemotherapy on its completion and survival outcomes in stage II colon cancer patients.
abstract: BACKGROUND
  Delayed chemotherapy is associated with inferior survival in stage III colon and stage II/III rectal cancer patients, but similar studies have not been performed in stage II colon cancer patients. We investigate the association between delayed and incomplete chemotherapy, and the association of delayed chemotherapy with survival in stage II colon cancer patients.
  
  
  METHODS
  Patients (age ≥ 66) diagnosed as stage II colon cancer and received chemotherapy from 1992 to 2005 were identified from the linked SEER-Medicare database. The association between delayed and incomplete chemotherapy was assessed using unconditional and conditional logistic regressions. Survival outcomes were assessed using stratified Cox regression based on propensity score matched samples.
  
  
  RESULTS
  4,209 stage II colon cancer patients were included, of whom 73.0% had chemotherapy initiated timely (≤ 2 months after surgery), 14.7% had chemotherapy initiated with moderate delay (2-3 months), and 12.3% had delayed chemotherapy (≥ 3 months). Delayed chemotherapy was associated with not completing chemotherapy (adjusted odds ratio (OR): 1.33 (95% confidence interval: 1.11, 1.59) for moderately delayed group, adjusted OR: 2.60 (2.09, 3.24) for delayed group). Delayed chemotherapy was associated with worse survival outcomes (hazard ratio (HR): 1.75 (1.29, 2.37) for overall survival; HR: 4.23 (2.19, 8.20) for cancer-specific survival).
  
  
  CONCLUSIONS
  Although the benefit of chemotherapy is unclear in stage II colon cancer patients, delay in initiation of chemotherapy is associated with an incomplete chemotherapy course and poorer survival, especially cancer-specific survival. Causal inference in the association between delayed initiation of chemotherapy and inferior survival requires further investigation.
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America; Department of Gastroenterology, University Hospitals Case Medical Center, Cleveland, Ohio, United States of America.
authors.forename: Fang
authors.initials: F
authors.lastname: Xu
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America.
authors.forename: Alfred A
authors.initials: AA
authors.lastname: Rimm
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Pingfu
authors.initials: P
authors.lastname: Fu
authors.affiliation: Division of Hematology and Oncology, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Smitha S
authors.initials: SS
authors.lastname: Krishnamurthi
authors.affiliation: Department of Gastroenterology, University Hospitals Case Medical Center, Cleveland, Ohio, United States of America; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Cooper
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D009367:Neoplasm Staging; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States