Adjuvant chemotherapy for stage III colon cancer: Do physicians agree about the importance of patient age and comorbidity?

Nancy L. Keating, Mary Beth Landrum, Carrie N. Klabunde, Robert H. Fletcher, Selwyn O. Rogers, William R. Doucette, Diana Tisnado, Steven Clauser, Katherine L. Kahn

Research output: Contribution to journalArticle

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Abstract

Purpose: We surveyed cancer physicians to understand how patients' age and comorbidity influence adjuvant chemotherapy recommendations and whether physician or practice characteristics also affect these recommendations. Methods: National survey of surgeons and medical oncologists caring for patients with colorectal cancer regarding whether they would recommend adjuvant chemotherapy for hypothetical patients with stage III colon cancer who varied by age (55 v 80 years) and comorbid illness (none, moderate, severe congestive heart failure [CHF]). Repeated measures logistic regression was used to assess the influence of patient, physician, and practice characteristics on chemotherapy recommendations. Results: Of 1,096 physicians, nearly all recommended chemotherapy for patients who were 55 years old with no comorbidity (99.0%), 55-years old with moderate CHF (88.6%), or 80 years old with no comorbidity (92.6%); many fewer recommended chemotherapy for 55-year-old patients with severe CHF (24.9%) or 80-year-old patients with moderate (47.2%) or severe (9.0%) CHF (P < .001). Younger physicians (P < .001) were more likely than others to recommend adjuvant chemotherapy overall, although physician factors explained little of the variability in recommendations. Conclusion: Physicians agree with guidelines recommending adjuvant chemotherapy for young, healthy patients with stage III colon cancer but differ widely on recommendations for patients who are older and sicker. Few physician or practice characteristics were associated with recommendations. For older and sicker patients, the individual physicians seen may have a substantial impact on the likelihood of receiving chemotherapy. Understanding better the sources of variation not explained by patients' clinical characteristics may allow improved tailoring of therapy to patients most likely to benefit.

Original languageEnglish (US)
Pages (from-to)2532-2537
Number of pages6
JournalJournal of Clinical Oncology
Volume26
Issue number15
DOIs
StatePublished - 2008
Externally publishedYes

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Adjuvant Chemotherapy
Colonic Neoplasms
Comorbidity
Physicians
Heart Failure
Drug Therapy
Colorectal Neoplasms
Logistic Models
Guidelines

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Keating, N. L., Landrum, M. B., Klabunde, C. N., Fletcher, R. H., Rogers, S. O., Doucette, W. R., ... Kahn, K. L. (2008). Adjuvant chemotherapy for stage III colon cancer: Do physicians agree about the importance of patient age and comorbidity? Journal of Clinical Oncology, 26(15), 2532-2537. https://doi.org/10.1200/JCO.2007.15.9434

Adjuvant chemotherapy for stage III colon cancer : Do physicians agree about the importance of patient age and comorbidity? / Keating, Nancy L.; Landrum, Mary Beth; Klabunde, Carrie N.; Fletcher, Robert H.; Rogers, Selwyn O.; Doucette, William R.; Tisnado, Diana; Clauser, Steven; Kahn, Katherine L.

In: Journal of Clinical Oncology, Vol. 26, No. 15, 2008, p. 2532-2537.

Research output: Contribution to journalArticle

Keating, NL, Landrum, MB, Klabunde, CN, Fletcher, RH, Rogers, SO, Doucette, WR, Tisnado, D, Clauser, S & Kahn, KL 2008, 'Adjuvant chemotherapy for stage III colon cancer: Do physicians agree about the importance of patient age and comorbidity?', Journal of Clinical Oncology, vol. 26, no. 15, pp. 2532-2537. https://doi.org/10.1200/JCO.2007.15.9434
Keating, Nancy L. ; Landrum, Mary Beth ; Klabunde, Carrie N. ; Fletcher, Robert H. ; Rogers, Selwyn O. ; Doucette, William R. ; Tisnado, Diana ; Clauser, Steven ; Kahn, Katherine L. / Adjuvant chemotherapy for stage III colon cancer : Do physicians agree about the importance of patient age and comorbidity?. In: Journal of Clinical Oncology. 2008 ; Vol. 26, No. 15. pp. 2532-2537.
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abstract = "Purpose: We surveyed cancer physicians to understand how patients' age and comorbidity influence adjuvant chemotherapy recommendations and whether physician or practice characteristics also affect these recommendations. Methods: National survey of surgeons and medical oncologists caring for patients with colorectal cancer regarding whether they would recommend adjuvant chemotherapy for hypothetical patients with stage III colon cancer who varied by age (55 v 80 years) and comorbid illness (none, moderate, severe congestive heart failure [CHF]). Repeated measures logistic regression was used to assess the influence of patient, physician, and practice characteristics on chemotherapy recommendations. Results: Of 1,096 physicians, nearly all recommended chemotherapy for patients who were 55 years old with no comorbidity (99.0{\%}), 55-years old with moderate CHF (88.6{\%}), or 80 years old with no comorbidity (92.6{\%}); many fewer recommended chemotherapy for 55-year-old patients with severe CHF (24.9{\%}) or 80-year-old patients with moderate (47.2{\%}) or severe (9.0{\%}) CHF (P < .001). Younger physicians (P < .001) were more likely than others to recommend adjuvant chemotherapy overall, although physician factors explained little of the variability in recommendations. Conclusion: Physicians agree with guidelines recommending adjuvant chemotherapy for young, healthy patients with stage III colon cancer but differ widely on recommendations for patients who are older and sicker. Few physician or practice characteristics were associated with recommendations. For older and sicker patients, the individual physicians seen may have a substantial impact on the likelihood of receiving chemotherapy. Understanding better the sources of variation not explained by patients' clinical characteristics may allow improved tailoring of therapy to patients most likely to benefit.",
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T2 - Do physicians agree about the importance of patient age and comorbidity?

AU - Keating, Nancy L.

AU - Landrum, Mary Beth

AU - Klabunde, Carrie N.

AU - Fletcher, Robert H.

AU - Rogers, Selwyn O.

AU - Doucette, William R.

AU - Tisnado, Diana

AU - Clauser, Steven

AU - Kahn, Katherine L.

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N2 - Purpose: We surveyed cancer physicians to understand how patients' age and comorbidity influence adjuvant chemotherapy recommendations and whether physician or practice characteristics also affect these recommendations. Methods: National survey of surgeons and medical oncologists caring for patients with colorectal cancer regarding whether they would recommend adjuvant chemotherapy for hypothetical patients with stage III colon cancer who varied by age (55 v 80 years) and comorbid illness (none, moderate, severe congestive heart failure [CHF]). Repeated measures logistic regression was used to assess the influence of patient, physician, and practice characteristics on chemotherapy recommendations. Results: Of 1,096 physicians, nearly all recommended chemotherapy for patients who were 55 years old with no comorbidity (99.0%), 55-years old with moderate CHF (88.6%), or 80 years old with no comorbidity (92.6%); many fewer recommended chemotherapy for 55-year-old patients with severe CHF (24.9%) or 80-year-old patients with moderate (47.2%) or severe (9.0%) CHF (P < .001). Younger physicians (P < .001) were more likely than others to recommend adjuvant chemotherapy overall, although physician factors explained little of the variability in recommendations. Conclusion: Physicians agree with guidelines recommending adjuvant chemotherapy for young, healthy patients with stage III colon cancer but differ widely on recommendations for patients who are older and sicker. Few physician or practice characteristics were associated with recommendations. For older and sicker patients, the individual physicians seen may have a substantial impact on the likelihood of receiving chemotherapy. Understanding better the sources of variation not explained by patients' clinical characteristics may allow improved tailoring of therapy to patients most likely to benefit.

AB - Purpose: We surveyed cancer physicians to understand how patients' age and comorbidity influence adjuvant chemotherapy recommendations and whether physician or practice characteristics also affect these recommendations. Methods: National survey of surgeons and medical oncologists caring for patients with colorectal cancer regarding whether they would recommend adjuvant chemotherapy for hypothetical patients with stage III colon cancer who varied by age (55 v 80 years) and comorbid illness (none, moderate, severe congestive heart failure [CHF]). Repeated measures logistic regression was used to assess the influence of patient, physician, and practice characteristics on chemotherapy recommendations. Results: Of 1,096 physicians, nearly all recommended chemotherapy for patients who were 55 years old with no comorbidity (99.0%), 55-years old with moderate CHF (88.6%), or 80 years old with no comorbidity (92.6%); many fewer recommended chemotherapy for 55-year-old patients with severe CHF (24.9%) or 80-year-old patients with moderate (47.2%) or severe (9.0%) CHF (P < .001). Younger physicians (P < .001) were more likely than others to recommend adjuvant chemotherapy overall, although physician factors explained little of the variability in recommendations. Conclusion: Physicians agree with guidelines recommending adjuvant chemotherapy for young, healthy patients with stage III colon cancer but differ widely on recommendations for patients who are older and sicker. Few physician or practice characteristics were associated with recommendations. For older and sicker patients, the individual physicians seen may have a substantial impact on the likelihood of receiving chemotherapy. Understanding better the sources of variation not explained by patients' clinical characteristics may allow improved tailoring of therapy to patients most likely to benefit.

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