• Login
    View Item 
    •   Home
    • The Christie Research Publications Repository
    • All Christie Publications
    • View Item
    •   Home
    • The Christie Research Publications Repository
    • All Christie Publications
    • View Item
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Browse

    All of ChristieCommunitiesTitleAuthorsIssue DateSubmit DateSubjectsThis CollectionTitleAuthorsIssue DateSubmit DateSubjectsProfilesView

    My Account

    LoginRegister

    Local Links

    The Christie WebsiteChristie Library and Knowledge Service

    Statistics

    Display statistics

    Determinants of variation in the use of adjuvant chemotherapy for stage III colon cancer in England

    • CSV
    • RefMan
    • EndNote
    • BibTex
    • RefWorks
    Authors
    Boyle, JM
    Kuryba, A
    Cowling, TE
    Aggarwal, A
    Hill, J
    van der Meulen, J
    Walker, K
    Braun, Michael S
    Affiliation
    Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
    Issue Date
    2020
    
    Metadata
    Show full item record
    Abstract
    AIMS: Adjuvant chemotherapy (ACT) for stage III colon cancer is well-established. This study aimed to explore the determinants of ACT use and between-hospital variation within the English National Health Service (NHS). MATERIALS AND METHODS: In total, 11 932 patients (diagnosed 2014-2017) with pathological stage III colon cancer in the English NHS were identified from the National Bowel Cancer Audit. Records were linked to Systemic Anti-Cancer Therapy and Hospital Episode Statistics databases. Multi-level logistic regression analyses were carried out to estimate independent factors for ACT use, including age, sex, deprivation, comorbidities, performance status, American Society of Anaesthesiologists (ASA) grade, surgical urgency, surgical access, TNM staging, readmission and hospital-level factors (university teaching hospital, on-site chemotherapy and high-volume centre). A random intercept was modelled for each English NHS hospital (n = 142). Between-hospital variation was explored using funnel plot methodology. Fully adjusted random-intercept models were fitted separately in young (<70 years) and elderly (³70 years) patients and intra-class correlation coefficients estimated. RESULTS: 60.7% of patients received ACT. Age was the strongest determinant. Compared with patients aged <60 years, those aged 60-64 (adjusted odds ratio [aOR] 0.76, 95% confidence interval 0.63-0.93), 65-69 (aOR 0.63, 95% confidence interval 0.54-0.74), 70-74 (aOR 0.53, 95% confidence interval 0.44-0.62), 75-79 (aOR 0.23, 95% confidence interval 0.19-0.27) and ³80 years (aOR 0.05, 95% confidence interval 0.04-0.06) were significantly less likely to receive ACT. With adjustment for other factors, ACT use was more likely in patients with higher socioeconomic status, fewer comorbidities, better performance status, lower ASA grade, advanced disease, elective resections, laparoscopic procedures and no unplanned readmissions. Hospital-level factors were non-significant. The observed proportions of ACT administration in the young and elderly were 46-100% (80% of hospitals 74-90%) and 10-81% (80% of hospitals 33-65%), respectively. Risk adjustment did not reduce between-hospital variation. Despite adjustment, age accounted for 9.9% (7.2-13.4%) of between-hospital variation in the elderly compared with 2.7% (1.2-5.7%) in the young. CONCLUSIONS: There is significant between-hospital variation in ACT use for stage III colon cancer, especially for older patients. Advanced age alone seems to be a greater barrier to ACT use in some hospitals.
    Citation
    Boyle JM, Kuryba A, Cowling TE, Aggarwal A, Hill J, van der Meulen J, et al. Determinants of Variation in the Use of Adjuvant Chemotherapy for Stage III Colon Cancer in England. Clin Oncol (R Coll Radiol). 2020.
    Journal
    Clinical Oncology
    URI
    http://hdl.handle.net/10541/622706
    DOI
    10.1016/j.clon.2019.12.008
    PubMed ID
    31926818
    Additional Links
    https://dx.doi.org/10.1016/j.clon.2019.12.008
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.clon.2019.12.008
    Scopus Count
    Collections
    All Christie Publications

    entitlement

    Related articles

    • Large age and hospital-dependent variation in administration of adjuvant chemotherapy for stage III colon cancer in southern Netherlands.
    • Authors: van Steenbergen LN, Rutten HJT, Creemers GJ, Pruijt JFM, Coebergh JWW, Lemmens VEPP
    • Issue date: 2010 Jun
    • Use and Effectiveness of Adjuvant Chemotherapy for Stage III Colon Cancer: A Population-Based Study.
    • Authors: Booth CM, Nanji S, Wei X, Peng Y, Biagi JJ, Hanna TP, Krzyzanowska MK, Mackillop WJ
    • Issue date: 2016 Jan
    • Administration of adjuvant chemotherapy for stage II-III colon cancer patients: An European population-based study.
    • Authors: Babaei M, Balavarca Y, Jansen L, Lemmens V, van Erning FN, van Eycken L, Vaes E, Sjövall A, Glimelius B, Ulrich CM, Schrotz-King P, Brenner H
    • Issue date: 2018 Apr 1
    • Impact of age on the use of adjuvant treatments in patients undergoing surgery for colorectal cancer: patients with stage III colon or stage II/III rectal cancer.
    • Authors: Sarasqueta C, Perales A, Escobar A, Baré M, Redondo M, Fernández de Larrea N, Briones E, Piera JM, Zunzunegui MV, Quintana JM, REDISECC-CARESS/CCR group
    • Issue date: 2019 Jul 25
    • Adjuvant chemotherapy for stage III colon cancer: implications of race/ethnicity, age, and differentiation.
    • Authors: Jessup JM, Stewart A, Greene FL, Minsky BD
    • Issue date: 2005 Dec 7
    DSpace software (copyright © 2002 - 2025)  DuraSpace
    Quick Guide | Contact Us
    Open Repository is a service operated by 
    Atmire NV
     

    Export search results

    The export option will allow you to export the current search results of the entered query to a file. Different formats are available for download. To export the items, click on the button corresponding with the preferred download format.

    By default, clicking on the export buttons will result in a download of the allowed maximum amount of items.

    To select a subset of the search results, click "Selective Export" button and make a selection of the items you want to export. The amount of items that can be exported at once is similarly restricted as the full export.

    After making a selection, click one of the export format buttons. The amount of items that will be exported is indicated in the bubble next to export format.