title: A population-based cohort study on adherence to practice guidelines for adjuvant chemotherapy in colorectal cancer.
abstract: BACKGROUND
  The value of adjuvant chemotherapy in colorectal cancer is well studied, and guidelines have been established. Little is known about how treatment guidelines are implemented in the everyday clinical setting.
  
  
  METHODS
  This national population-based study on nearly 34,000 patients with colorectal cancer evaluates the adherence to present clinical guidelines for adjuvant chemotherapy. Virtually all patients with colorectal cancer in Sweden during the years 2007-2012 and data from the Swedish Colorectal Cancer Registry were included.
  
  
  RESULTS
  In colon cancer stage III, adherence to national guidelines was associated with lower age, presence of multidisciplinary team (MDT) conference, low co-morbidity, and worse N stage. The MDT forum also affected whether or not high-risk stage II colon cancer patients were considered for adjuvant chemotherapy. Rectal cancer patients both in stage II and III were considered for adjuvant chemotherapy less often than colon cancer patients, but the same factors influenced the decision. Adjuvant chemotherapy was started later than eight weeks after surgery in 30% of colon cancer patients and in 38% of rectal cancer patients.
  
  
  CONCLUSIONS
  In Sweden, the adherence to national guidelines for adjuvant chemotherapy in colon cancer stage III is acceptable in younger and healthier patients. MDT conferences are of major importance and affect whether patients are recommended for adjuvant chemotherapy. Special consideration needs to be given to certain subgroups of patients, particularly older patients and patients with poorly differentiated tumors. There is a need to shorten the waiting time until start of chemotherapy.
authors.affiliation: Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. elinor.bexe-lindskog@surgery.gu.se.
authors.forename: Elinor Bexe
authors.initials: EB
authors.lastname: Lindskog
authors.forename: Katrín Ásta
authors.initials: KÁ
authors.lastname: Gunnarsdóttir
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Derwinger
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Wettergren
authors.forename: Bengt
authors.initials: B
authors.lastname: Glimelius
authors.forename: Karl
authors.initials: K
authors.lastname: Kodeda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D003131:Combined Modality Therapy; D066264:Datasets as Topic; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011159:Population Surveillance; D012042:Registries; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology