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Treatment of Colorectal Cancer in the Rural Community Hospital Setting: Compatibility to Standard Care, Risk Factors to Deviate From Standard
Kaori Ito*, Darcy D. Shaw, John C. Hardaway, Ramiz Kseri, Caela a. Hesano, Jessica Wummel, Pam S. Haan, Cheryl Anderson, Hiromichi Ito
Surgery, Michigan State University, East Lansing, MI
Background: Following the current treatment guidelines for primary colorectal cancer (CRC) is critical to improve the outcomes of the patients with CRC and the deviation from the standard is associated with the poor prognosis. We conducted this study to assess the quality of treatment of CRC in a rural community hospital setting, and to find risk factors for deviation of standard care.
Methods: The medical records of patients who underwent surgical resection for primary CRC at two regional community hospitals were reviewed. The demographics of patients, type of therapies received including surgery and adjuvant therapy, and long-term outcomes were analyzed. For the patients with stage III cancer, the time from the operation to the initiation of adjuvant therapy were also evaluated.
Results: From 1999 through 2012, 1293 patients with CRC were identified and included in the study. There were 621 males (48.0%) and the median age was 71 years (range 23 - 100). The median follow up period for the entire cohort was 46.1 months (range 0.1 - 170.1). The distribution of patients over stages and their long-term outcomes were as shown in the table. Among 371 patients with stage III CRC, only 190 patients (51.2%) received adjuvant chemotherapy. The initiation of adjuvant chemotherapy was delayed greater than 8 weeks after their operation in 39 patients (20.5 %) and their long-term outcomes were significantly worse compared to those who started adjuvant chemotherapy within 8 weeks post-operatively (median survival; 55 months vs 96 months, 5-year survival rate; 44% vs 65%, p<0.0001, respectively, Figure). Marital status (widowed) (23.1% vs 7.3%, p=0.004) and renal failure (2.5% vs 0%, p=0.049) were identified as risk factors for delayed adjuvant therapy.
Conclusions: In our community hospital setting, for patients with stage III CRC, underutilization of chemotherapy and failure to initiate it at the timely fashion are common and they compromises long-term outcomes. Enlightment of the community to use adjuvant chemotherapy in adequate timing for stage III patients is necessary to improve the outcomes. Long-term outcomes of patients with CRC by stage | Stage | N | Median survival (months) | 5-year-survival rate (%) | | 0 | 68 (5%) | 122 | 80 | | I | 372 (29%) | 125 | 74 | | II | 329 (25%) | 80 | 58 | | III | 371 (29%) | 54 | 48 | | IV | 153 (12%) | 17 | 9 |
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