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Prognostic factors of adjuvant chemotherapy discontinuation among stage III colon cancer patients: A survey of medical oncologists and a systematic review and meta-analysis.
Cancer Med 2020CM

Abstract

BACKGROUND

Factors that are prognostic of early discontinuation of adjuvant chemotherapy among stage III colon cancer patients have yet to be described. To address this gap, a survey of medical oncologists and a systematic review and meta-analysis were conducted.

METHODS

A survey was distributed in March 2019 to medical oncologists who treat colon cancer within Alberta, Canada. Clinicians were asked to rank the prognostic importance of a set of variables using a Likert scale and agreement was quantified using a weighted Cohen's kappa. In addition, we systematically searched four databases up to July 2019. Meta-analyses were conducted using a random-effects model.

RESULTS

Of the 25 clinicians who were sent the survey, 14 responded. Overall, there was no agreement regarding which variables were prognostic of early discontinuation (weighted Cohen's kappa = 0.12; 95% CI = 0.05-0.18). From an initial 3927 articles, 18 investigations were identified for inclusion in our review. Based upon evidence from both the survey and the systematic review, the following four variables were identified as being prognostic of early discontinuation: (a) comorbidity (OR2+ vs 0 = 1.53; 95% CI = 1.30-1.79); (b) performance status (ORECOG 2+ vs 0-1 = 1.33; 95%CI = 1.07-1.65); (c) T stage (ORT4 vs T1-2 = 1.57; 95% CI = 0.99-2.50); and (d) chemotherapy regimen (estimates not pooled due to heterogeneity). In addition to these factors, there was some suggestion that age, marital status/social support, muscle mass, N stage, and tumor grade had prognostic value.

CONCLUSIONS

Current evidence is heterogeneous and limited. Additional research is needed to confirm our findings and to explore additional prognostic factors.

Authors+Show Affiliations

Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada.Department of Public Health Sciences, Faculty of Medicine, Queen's University, Kingston, Ontario, Canada.Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada.Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada. Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada. Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31962372

Citation

Boyne, Devon J., et al. "Prognostic Factors of Adjuvant Chemotherapy Discontinuation Among Stage III Colon Cancer Patients: a Survey of Medical Oncologists and a Systematic Review and Meta-analysis." Cancer Medicine, 2020.
Boyne DJ, O'Sullivan DE, Heer EV, et al. Prognostic factors of adjuvant chemotherapy discontinuation among stage III colon cancer patients: A survey of medical oncologists and a systematic review and meta-analysis. Cancer Med. 2020.
Boyne, D. J., O'Sullivan, D. E., Heer, E. V., Hilsden, R. J., Sajobi, T. T., Cheung, W. Y., ... Friedenreich, C. M. (2020). Prognostic factors of adjuvant chemotherapy discontinuation among stage III colon cancer patients: A survey of medical oncologists and a systematic review and meta-analysis. Cancer Medicine, doi:10.1002/cam4.2843.
Boyne DJ, et al. Prognostic Factors of Adjuvant Chemotherapy Discontinuation Among Stage III Colon Cancer Patients: a Survey of Medical Oncologists and a Systematic Review and Meta-analysis. Cancer Med. 2020 Jan 21; PubMed PMID: 31962372.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic factors of adjuvant chemotherapy discontinuation among stage III colon cancer patients: A survey of medical oncologists and a systematic review and meta-analysis. AU - Boyne,Devon J, AU - O'Sullivan,Dylan E, AU - Heer,Emily V, AU - Hilsden,Robert J, AU - Sajobi,Tolulope T, AU - Cheung,Winson Y, AU - Brenner,Darren R, AU - Friedenreich,Christine M, Y1 - 2020/01/21/ PY - 2019/10/07/received PY - 2019/12/23/revised PY - 2019/12/30/accepted PY - 2020/1/22/entrez PY - 2020/1/22/pubmed PY - 2020/1/22/medline KW - adherence KW - adjuvant chemotherapy KW - colorectal neoplasms KW - completion KW - discontinuation JF - Cancer medicine JO - Cancer Med N2 - BACKGROUND: Factors that are prognostic of early discontinuation of adjuvant chemotherapy among stage III colon cancer patients have yet to be described. To address this gap, a survey of medical oncologists and a systematic review and meta-analysis were conducted. METHODS: A survey was distributed in March 2019 to medical oncologists who treat colon cancer within Alberta, Canada. Clinicians were asked to rank the prognostic importance of a set of variables using a Likert scale and agreement was quantified using a weighted Cohen's kappa. In addition, we systematically searched four databases up to July 2019. Meta-analyses were conducted using a random-effects model. RESULTS: Of the 25 clinicians who were sent the survey, 14 responded. Overall, there was no agreement regarding which variables were prognostic of early discontinuation (weighted Cohen's kappa = 0.12; 95% CI = 0.05-0.18). From an initial 3927 articles, 18 investigations were identified for inclusion in our review. Based upon evidence from both the survey and the systematic review, the following four variables were identified as being prognostic of early discontinuation: (a) comorbidity (OR2+ vs 0 = 1.53; 95% CI = 1.30-1.79); (b) performance status (ORECOG 2+ vs 0-1 = 1.33; 95%CI = 1.07-1.65); (c) T stage (ORT4 vs T1-2 = 1.57; 95% CI = 0.99-2.50); and (d) chemotherapy regimen (estimates not pooled due to heterogeneity). In addition to these factors, there was some suggestion that age, marital status/social support, muscle mass, N stage, and tumor grade had prognostic value. CONCLUSIONS: Current evidence is heterogeneous and limited. Additional research is needed to confirm our findings and to explore additional prognostic factors. SN - 2045-7634 UR - https://www.unboundmedicine.com/medline/citation/31962372/Prognostic_factors_of_adjuvant_chemotherapy_discontinuation_among_stage_III_colon_cancer_patients:_A_survey_of_medical_oncologists_and_a_systematic_review_and_meta-analysis L2 - https://doi.org/10.1002/cam4.2843 DB - PRIME DP - Unbound Medicine ER -