Table 6.
Patterns of care for the initial receipt of chemotherapy for colorectal cancer in the United States and Canada*
| Site | First author, year (ref.) | Country | Stage | Diagnosis year | Sample size | Age, y, %† | Health delivery setting and data sources | Findings |
|---|---|---|---|---|---|---|---|---|
| Colon | Kirkpatrick, 2010 (39) | United States | II | 1995–2003 | 287 | ≥65, 69 | Texas; patients identified through the Baylor University Medical Center tumor registry; health services data from chart review | Among patients receiving resection, 56% were referred to a medical oncologist, 28% received adjuvant chemotherapy; receipt of chemotherapy was associated with age at diagnosis, comorbidity score, tumor grade, and stage |
| Winget, 2010 (40) | Canada | III | 1999–2000 | 772 | ≥70, 56 | Alberta; patients identified from the registry; health services data obtained from hospital discharge data and EMRs | Among patients who received surgery, 80% received an oncologist consultation within 6 mo of diagnosis; 63% of patients with an oncologist consultation received chemotherapy | |
| Earle, 2009 (41) | United States | II | 2005–2008 | 258 | ≥65, 46 | Multiple states; patients and health services data identified from the NCCN Colon/Rectum Cancer Outcomes Database | 46% of patients received chemotherapy; 77% of patients who initiated chemotherapy completed at least 4 mo of therapy; an oxaliplatin-containing regimen was used for 67% of patients | |
| Hardiman, 2009 (9) | United States | Any | 1998–2004 | 10 433 | ≥80, 30 | Oregon; patients and health services data identified through the Oregon State Cancer Registry | Patients aged ≥80 y received chemotherapy less often than younger patients; older patients who did receive chemotherapy were less likely to receive multiple agents | |
| Hershman, 2009 (42) | United States | NR | 1991–2002 | 13 422 | ≥65, 100 | Multiple states; patients and health services data identified from SEER–Medicare | Study cohort was limited to patients who received chemotherapy; 17% received erythropoiesis-stimulating agents | |
| Wirtzfeld, 2009 (43) | Canada | I–III | 1999–2000 | 419 | NR | Newfoundland and Labrador, Ontario; patient and health services data from the Newfoundland and Labrador Familial Colorectal Cancer Registry, the Ontario Familial Colorectal Cancer Registry, medical record review, and questionnaire | 0% of stage I, 37% of stage II, and 92% of stage III colon cancer patients received chemotherapy | |
| Romanus, 2009 (32) | United States | I–IV | 2005–2008 | 2042 | ≥65, 50 | Multiple states; patients and health services data obtained from the NCCN Outcomes Database Project | 90% of stage III patients aged ≤80 y received chemotherapy within 4 mo of diagnosis | |
| Bradley, 2008 (44) | United States | I–IV | 1997–2000 | 4675 | ≥66, 100 | Michigan; patients identified from the registry; health services data identified from Medicare and Medicaid insurance claims | Oncologist consultations were received by 81% of Medicaid beneficiaries and 85% of Medicare-only beneficiaries; 23% of Medicaid beneficiaries and 34% of Medicare-only beneficiaries initiated chemotherapy; of these, 48% of Medicaid beneficiaries and 62% of Medicare-only beneficiaries completed chemotherapy regimens | |
| Quah, 2007 (45) | United States | I–III | 1990–2001 | 1327 | Median 70 | New York; patients and health services data identified from the MSKCC Colorectal Service Database and chart review | Younger patients (≤40 y) were more likely to receive chemotherapy compared with older patients: 39% vs 14% of stage II patients, 87% vs 80% of stage III patients | |
| Dobie, 2006 (46) | United States | III | 1992–1996 | 5778 | ≥66, 100 | Multiple states; patients and health services data identified from SEER–Medicare | Researchers classified receipt of chemotherapy using both liberal (1 claim-day in a month) and conservative (3 claim-days in a month) definitions; by the conservative definition, 16% initiated and 38% completed chemotherapy; by the liberal definition, 12% initiated and 42% completed chemotherapy | |
| Luo, 2006 (47) | United States | III | 1992–1999 | 8978 | ≥66, 100 | Multiple states; patients and health services data identified from SEER–Medicare | 78% of patients saw an oncologist within 6 mo of diagnosis; 59% of patients received chemotherapy within 6 mo of diagnosis; consultation with a medical oncologist, younger age, white race, being married, and later year of diagnosis were associated with receipt of chemotherapy | |
| McGory, 2006 (48) | United States | III | 1994–2001 | 13 231 | Mean 69 | California; patients identified from the registry; health services data from California Patient Discharge Database | 48% of patients received chemotherapy | |
| Neugut, 2006 (49) | United States | III | 1995–1999 | 3733 | ≥65, 100 | Multiple states; patients and health services data identified from SEER–Medicare | More than 30% of patients were treated with chemotherapy for 1 to 4 mo; chemotherapy treatment for 5–7 mo was associated with younger age, more recent year of diagnosis, being married, having a tumor of well/moderately differentiated grade, and having no comorbidities | |
| Baldwin, 2005 (50) | United States | III | 1992–1996 | 5294 | ≥66, 100 | Multiple states; patients and health services data identified from SEER–Medicare | There was no difference in the proportions of white and black patients who received consultation with an oncologist (79% and 79%, respectively, P = 0.922); however, a significant difference in treatment receipt was observed where 70% of whites and 60% of blacks received chemotherapy (P < 0.001) | |
| Jessup, 2005 (51) | United States | III | 1990–2002 | 85 934 | ≥60, 79 | Multiple states; patients and health services data from the National Cancer Data Base | Use of adjuvant chemotherapy increased from 39% in 1990 to 64% in 2002; these percentages include the use of both chemotherapy and biological response-modifiers (primarily 5-FU, levamisole, and BCG vaccine) | |
| Keating, 2005 (52) | United States | III | 1993–1999 | 48 027 | ≥66, 100 | Multiple states; patients and health services data identified from SEER–Medicare | Increases in market share of managed care by county was not associated with receipt of adjuvant chemotherapy (P = .94) | |
| Wu, 2004 (53) | United States | III | 2001 | 303 | ≥65, 63 | Louisiana; patients identified from the registry; health services data from medical records of patients treated in CoC and non-CoC hospitals | Receipt of chemotherapy based on race/sex was as follows: 65% white/male, 66% white/female, 72% black/male, 66% black/female; 75% of patients treated at CoC hospital and 54% at non-CoC hospital | |
| Sundararajan, 2002 (54) | United States | III–IV | 1992–1996 | 4768 | ≥65, 100 | Multiple states; patients and health services data identified from SEER–Medicare | 4% of patients received chemotherapy that did not include 5-FU, whereas 52% received 5-FU-based therapy; younger age was strongly associated with receiving 5-FU treatment | |
| Schrag, 2001 (55) | United States | III | 1991–1996 | 6262 | ≥65, 100 | Multiple states; patients and health services data identified from SEER–Medicare | 55% of all patients received chemotherapy; older age was associated with decreased likelihood of receipt of chemotherapy | |
| Sundararajan, 2001 (56) | United States | III | 1992–1996 | 4998 | ≥65, 100 | Multiple states; patients and health services data identified from SEER–Medicare | Approximately 50% of patients received 5-FU during the study period; use of 5-FU increased by 10% between 1992 and 1996 | |
| Rectal | Kuo, 2010 (30) | United States | II | 1994–2003 | 329 | Range 28–93 | California; patients and health services data identified through the registry’s Desert Sierra Cancer Surveillance Program | 45% of patients received chemotherapy; among these, 11% of patients received chemotherapy only in addition to surgery |
| Pisu, 2010 (10) | United States | I–III | 1999–2003 | 675 | ≥65, 100 | Alabama; patients identified through registry; health services data from Medicare claims | 11% of patients received neoadjuvant chemotherapy; 37% received adjuvant chemotherapy | |
| Romanus, 2009 (32) | United States | I–IV | 2005–2008 | 2042 | ≥65, 50 | Multiple states; patients and health services data obtained from the NCCN Outcomes Database Project | 81% of stage II/III patients aged ≤80 y received chemotherapy within 4 mo of diagnosis | |
| Demers, 2008 (13) | Canada | NR | 1985–1999 | 2925 | ≥60, 79 | Manitoba; patients and health services data from CancerCare Manitoba (cancer registry and treatment data) | Receipt of chemotherapy increased 13% to 37% between 1985 and 1999 | |
| Dobie, 2008 (33) | United States | II–III | 1992–1999 | 2886 | ≥66, 100 | Multiple states; patients and health services data identified from SEER–Medicare | 52% of all patients received chemotherapy; 42% of stage II and 63% of stage III patients received chemotherapy | |
| Morris, 2008 (34) | United States | II–III | 1992–1999 | 2716 | ≥66, 100 | Multiple states; patients and health services data identified from SEER–Medicare | 73% of blacks and 75% of whites consulted with a medical oncologist; following consultation, 54% of blacks and 70% of whites received chemotherapy | |
| Morris, 2006 (17) | United States | I–IV | 1992–1999 | 10 940 | ≥65, 100 | Multiple states; patients and health services data identified from SEER–Medicare | Among patients with stage II to IV disease, black patients were less likely to receive chemotherapy compared with white patients (27% vs 40%) | |
| Phang, 2003 (20) | Canada | 0–IV | 1996 | 481 | Median 70 | British Columbia; patients were identified through the British Columbia Cancer Agency; chart review and physician surveys were used to obtain health services data | 60% of stage II and stage III patients received adjuvant chemotherapy | |
| Neugut, 2002 (36) | United States | II–III | 1991–2002 | 55 204 | ≥65, 100 | Multiple states; patients and health services data identified from SEER–Medicare | Overall, 51% of patients received adjuvant chemotherapy with 5-FU-containing regimens; 14% of patients received a 5-FU regimen only in addition to surgery | |
| Shroen, 2001 (21) | United States | I–IV | 1994–1996 | 637 | Range 22–94 | Sacramento, California; patients and health services data identified from the Cancer Surveillance Program | 11% of stage I patients, 54% of stage II patients, 70% of stage III patients, and 55% of stage IV patients received chemotherapy | |
| Colorectal | Chan, 2010 (22) | Canada | IV | 2000–2002 | 411 | ≥70, 40 | British Columbia; patients and health services data identified through the British Columbia Cancer Agency | 61% of resected patients and 58% nonresected patients received chemotherapy |
| Hendren, 2010 (57) | United States | III | 1998–2005 | 17 108 | ≥65, 100 | Multiple states; patients and health services data identified from SEER–Medicare; patients receiving RT were excluded | 66% of patients received adjuvant chemotherapy; surgical complications were associated with nonreceipt of chemotherapy | |
| Oliveria, 2004 (58) | United States | I–IV | 1997–1999 | 217 | Mean 72 | Massachusetts; patient and health services data obtained from HMO administrative data and medical record review | 48% of stage I patients, 60% of stage II patients, 87% of stage III patients, and 67% of stage IV patients received consultation with an oncologist; among those who received consultation with an oncologist, 14% of stage I patients, 44% of stage II patients, 67% of stage III patients, and 61% of stage IV patients received chemotherapy | |
| Ayanian, 2003 (38) | United States | II–III | 1996–1997 | 1956 | ≥18, 100 | California; patients were identified from the registry; health services data obtained from physician surveys or hospital records | Based on registry data, 59% of patients received chemotherapy; this proportion increased to 67% with additional data obtained from physician surveys or hospital records; older and unmarried patients were less likely to receive chemotherapy | |
| Wudel, 2002 (26) | United States | I–IV | 1990–1999 | 668 | Median 69, 74‡ | Tennessee; data were collected through cancer registry databases, a university medical center, and a city hospital in the Nashville area | There was no difference in chemotherapy receipt by race or hospital; at the university hospital, 16% of black patients and 21% of white patients received chemotherapy; at the city hospital, 16% of black patients and 25% of white patients received chemotherapy | |
| Roetzheim, 2000 (27) | United States | Any | 1994 | 9551 | Mean 72 | Florida; patients identified through the Florida Cancer Data System; health services data were obtained from statewide hospital and ambulatory surgical centers, freestanding RT centers, and diagnostic imaging centers | Overall, 21% of patients received chemotherapy; a higher proportion of married, smoking, uninsured, distant stage, and rectal cancer patients received surgery |
* 5-FU = 5-Fluorouracil; CoC = Commission on Cancer; BCG = Bacillus Calmette–Guérin; EMR = electronic medical record; HMO = health maintenance organization; MSKCC = Memorial Sloan-Kettering Cancer Center; NCCN = National Comprehensive Cancer Network; NR = not reported; RT = radiotherapy; SEER = Surveillance, Epidemiology, and End Results.
† For studies where age distributions were not explicitly stated, we include measures of mean, median, or range as reflected in the original study’s presentation.
‡ Median shown at university medical center, city hospital, respectively.