Addressing the variation in adjuvant chemotherapy treatment for colorectal cancer (CRC): can a regional intervention promote national change?
Session type: Poster / e-Poster / Silent Theatre session
Analysis of routine population-based data has previously shown that surgery for patients with rectal cancer can vary widely. Through access to the Systemic Anti-Cancer Treatment (SACT) database we have quantified variation in adjuvant chemotherapy across England and in detail across a large representative region (Yorkshire and Humber).
National Cancer Registry and Analysis Service (NCRAS) provided data on individuals aged ≥18 years with stage II and III CRC who underwent major resection from 01/01/14 – 31/03/16. Chemotherapy data was obtained from the SACT dataset. Rates of chemotherapy were calculated from multilevel mixed logistic regression and adjusted for age, sex, socioeconomic status, Charlson comorbidity index score and stratified by tumour stage and site. A questionnaire addressing different clinical scenarios was sent to oncologists across the region.
The national adjusted chemotherapy treatment rate ranged from 2% to 43% & from 19% to 80% for patients with stage II and stage III cancers. Larger variation was seen for rectal than colon cancer, 10% to 70% vs 14% to 60%. Similar variation was seen in region and across subgroups.
A regional questionnaire obtained responses from 15 of 16 MDTs. Widest variation in opinions were observed for high risk stage II patients both with deficient and proficient mismatch repair tumours and stage IIIB patients over the age of 70.
Variation is seen across England in the use of adjuvant chemotherapy. Open discussion in our region has enabled consensus agreement on an algorithm for colon cancer, with one pending for rectal cancer.