Even at NCCN Institutions, a 'Sizable Minority' of Patients with Rectal Cancer Are Not Treated per NCCN Guidelines 

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Even at the eight cancer centers participating in the National Comprehensive Cancer Network (NCCN) Colorectal Cancer Outcomes project, a “sizable minority” of patients with stage II/III rectal cancer treated with curative intent neoadjuvant chemoradiotherapy did not complete postoperative chemotherapy, according to a study published in the Journal of Clinical Oncology. “Current NCCN Colorectal Cancer Guidelines recommend completion of a 6-month course of adjuvant chemotherapy for patients with stage II/III rectal cancer,” noted Polina Khrizman, MD, of Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, and coauthors.

Underlying Reasons

The study analyzed data for 1,193 patients with stage II/III rectal cancer receiving neoadjuvant chemoradiotherapy. Among the 203 patients (17%) not receiving any adjuvant chemotherapy, 67% were seen by a medical oncologist postoperatively, 20% were not, and it was unknown whether the remaining 13% were or were not seen by a medical oncologist. The most frequent reason chemotherapy was not recommended for patients seen by a medical oncologist was comorbid illness (25 of 50 patients, 50%). Other reasons cited were therapy not indicated, older age, disease recurrence, and death.

The most frequent reason chemotherapy was not received when recommended or discussed was patient refusal (54 of 74, 73%). Other reasons were recurrence before treatment was administered, no treatment documented at 12-month assessment, death, and transfer to another center. Factors significantly associated with not receiving adjuvant chemotherapy were age, Eastern Cooperative Oncology Group performance status ≥ 1, on Medicaid or indigent, complete pathologic response, reoperation/wound infection, and no closure of ileostomy/colostomy. ■

Khrizman P, et al: J Clin Oncol 31:30-38, 2013.




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