Timeliness of Adjuvant Chemotherapy for Stage III Adenocarcinoma of the Colon: A Measure of Quality of Care

We explored the effect of delays in administration of adjuvant Oxaliplatin/5-Fluorouracil/Leucovorin (FOLFOX) on the outcome of stage Ill colon cancer and found that delays beyond 120 days increased the probability of systemic recurrence. Therefore, implementation of quality measure(s) to assess the timeliness of adjuvant chemotherapy (AC) is desired and might improve the outcome. Background: Findings from multiple clinical trials established AC as a standard of care for stage Ill colon cancer. However, there is no recommended standard time for delivery of AC. We explored the timeliness of AC with FOLFOX as a predictor of recurrence and its role as a quality indicator in patients with stage Ill colon cancer. Patients and Methods: We conducted a retrospective analysis of patients with colon cancer who received AC at Los Angeles County Hospital and Norris Cancer Center between 2003 and 2011. Time to recurrence (TTR) was the primary end point of the study, Kaplan-Meier curves and log-rank tests were used to assess the association between timing of the AC and TTR. Results: We identified 102 patients with stage Ill colon cancer who had received AC. With a median follow-up of 3.2 years, time from surgery to AC was not a predictor of recurrence (P = .19). However, there was a nonsignificant trend toward higher risk of systemic recurrence when the delay of AC was more than 12 weeks (P = .068). Additionally, a significant association was found between age, race, type of hospital, and timeliness of AC. Conclusion: To date, our study is the largest data set to assess the timeliness of FOLFOX as a predictor of outcome in stage ill colon cancer. Because FOLFOX is the current standard for AC for colon cancer, we report a trend toward worse outcome when FOLFOX is delayed more than 12 weeks. This result, thus supports quality measures to assess the timeliness of AC in stage Ill colon cancer and might have a meaningful effect on the care of patients with colon cancer.