title: Why adjuvant chemotherapy for stage III colon cancer was not given: Reasons for non-recommendation by clinicians or patient refusal.
abstract: Aim The aim of our study was to evaluate stage III colon cancer patients discussed at a multidisciplinary team meeting to identify reasons for clinicians not recommending adjuvant chemotherapy and reasons for patients declining recommended chemotherapy. Methods A retrospective, single institution Australian study was conducted on all surgically managed stage III colon cancer patients diagnosed at the regional cancer centre at Toowoomba Hospital between July 2010 and December 2014. Reasons why adjuvant chemotherapy was not recommended by the multidisciplinary team or following referral to a medical oncologist and patients' reasons for refusing chemotherapy despite medical oncology recommendation were determined. Results One hundred and nine patients were suitable for evaluation. Overall, 72 (66.1%) received adjuvant chemotherapy. Chemotherapy was not recommended in 25 (23.4%) of patients, with the majority (68%) having more than one cited reason. Multiple comorbidities and advanced age were the most common reasons for non-recommendation ( p < 0.01). Age alone was not a reason for not recommending chemotherapy. Twelve (11%) patients declined offered chemotherapy. The reasons for refusal were not detailed in the majority of patient charts (63.6%). Travel distance was not a factor in accepting or refusing chemotherapy. Conclusion Discussion at a multidisciplinary team meeting facilitates the identification of patients unsuitable for adjuvant treatment. The reasons for declining offered chemotherapy need to be assessed fully to ensure that patients' treatment preferences are balanced against the proven benefits of chemotherapy. Attendance at a regional cancer centre provides the opportunity for high standard care in the management of stage III colon cancer.
authors.affiliation: 1 Cancer and Palliative Care Services, Toowoomba Hospital, Toowoomba, Australia.|2 School of Medicine, University of Queensland, Toowoomba Hospital, Toowoomba, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Gilbar
authors.affiliation: 1 Cancer and Palliative Care Services, Toowoomba Hospital, Toowoomba, Australia.|2 School of Medicine, University of Queensland, Toowoomba Hospital, Toowoomba, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lee
authors.affiliation: 1 Cancer and Palliative Care Services, Toowoomba Hospital, Toowoomba, Australia.|2 School of Medicine, University of Queensland, Toowoomba Hospital, Toowoomba, Australia.
authors.forename: Khageshwor
authors.initials: K
authors.lastname: Pokharel
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001315:Australia; D017024:Chemotherapy, Adjuvant; D000066491:Clinical Decision-Making; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D019983:Guideline Adherence; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010348:Patient Care Team / Q000592:standards; D012017:Referral and Consultation; D012189:Retrospective Studies; D012423:Rural Health / Q000706:statistics & numerical data; D059039:Standard of Care; D016312:Treatment Refusal / Q000706:statistics & numerical data*
chemical_list: D000970:Antineoplastic Agents
keywords: Adjuvant chemotherapy; age; colon cancer; comorbidities; multidisciplinary team