title: Norwegian patients with colon cancer start their adjuvant therapy too late.
abstract: BACKGROUND
  For patients with colon cancer who are to receive adjuvant chemotherapy according to national guidelines, such therapy must be initiated no more than 4-6 weeks after the surgical intervention. We wished to investigate whether these guidelines are being complied with. We also wished to see whether the type of surgery (open or laparoscopic) had any effect on the time elapsing before initiation of adjuvant therapy.
  
  
  METHODS
  The material includes 1,132 patients who had undergone surgery for colon cancer in the period 2008-2013 and who received adjuvant chemotherapy. Surgical treatment and adjuvant chemotherapy are defined through diagnosis and procedural codes in the Norwegian Patient Register for the period 2008-2013.
  
  
  RESULTS
  On average, 44.7 days passed after the surgical intervention before the patients commenced their adjuvant chemotherapy. For 49% of the patients, the adjuvant therapy was not initiated within the six-week deadline. Patients who had undergone laparoscopic surgery were hospitalised for shorter periods (6.5 days versus 10.7 days) and had fewer complications (7.6% versus 16.4%) when compared to patients who had undergone open surgery, yet still failed to start their adjuvant therapy correspondingly earlier.
  
  
  CONCLUSIONS
  Measures should be taken to improve quality, thus ensuring that the guidelines are complied with and that patients start their required adjuvant therapy earlier. For those who have undergone laparoscopic surgery, it ought to be simple to reap the gains from shorter hospitalisation periods and fewer complications in the form of a more rapid initiation of adjuvant therapy.
authors.affiliation: Senter for klinisk dokumentasjon og evaluering (SKDE) Helse Nord RHF.
authors.forename: Frank
authors.initials: F
authors.lastname: Olsen
authors.affiliation: Senter for klinisk dokumentasjon og evaluering (SKDE) Helse Nord RHF.
authors.forename: Bård
authors.initials: B
authors.lastname: Uleberg
authors.affiliation: Senter for klinisk dokumentasjon og evaluering (SKDE) Helse Nord RHF og Institutt for samfunnsmedisin Universitetet i Tromsø - Norges arktiske universitet.
authors.forename: Bjarne Koster
authors.initials: BK
authors.lastname: Jacobsen
authors.affiliation: Senter for klinisk dokumentasjon og evaluering (SKDE) Helse Nord RHF.
authors.forename: Lise
authors.initials: L
authors.lastname: Balteskard
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012042:Registries; D061665:Time-to-Treatment