Timing of adjuvant chemotherapy and its relation to survival among patients with stage III colon cancer

• 14% of 6620 colon cancer patients started adjuvant chemotherapy >8 weeks.
• Elderly patients were more likely to start chemotherapy >8 weeks post-surgery.
• Various treatment factors were associated with starting chemotherapy >8 weeks.
• Starting adjuvant chemotherapy >8 weeks was associated with decreased survival.
• Starting adjuvant chemotherapy 5–8 versus <4 weeks showed no difference in survival.

BackgroundCurrently available data suggest that delaying the start of adjuvant chemotherapy in colon cancer patients has a detrimental effect on survival. We analysed which factors impact on the timing of adjuvant chemotherapy and evaluated the influence on overall survival (OS).Patients and methodsStage III colon cancer patients who underwent resection and received adjuvant chemotherapy between 2008 and 2013 were selected from the Netherlands Cancer Registry. Timing of adjuvant chemotherapy was subdivided into: ⩽4, 5–6, 7–8, 9–10, 11–12 and 13–16 weeks post-surgery. Multivariable regressions were performed to assess the influence of several factors on the probability of starting treatment within 8 weeks post-surgery and to evaluate the association of timing of adjuvant chemotherapy with 5-year OS.Results6620 patients received adjuvant chemotherapy, 14% commenced after 8 weeks. Factors associated with starting treatment after 8 weeks were older age (Odds ratio (OR) 65–74 versus <65 years 1.3 (95% confidence interval (CI): 1.14–1.58); OR ⩾75 versus <65 years 1.6 (1.25–1.94)), emergency resection (OR 1.8 (1.41–2.32)), anastomotic leakage (OR 8.1 (6.14–10.62)), referral to another hospital for adjuvant chemotherapy (OR 1.9 (1.36–2.57)) and prolonged postoperative hospital admission (OR 4.7 (3.30–6.68)). Starting 5–8 weeks post-surgery showed no decrease in OS compared to initiation within 4 weeks (Hazard ratio (HR) 5–6 weeks 0.9 (0.79–1.11); HR 7–8 weeks 1.1 (0.91–1.30)). However, commencing beyond 8 weeks was associated with decreased OS compared to initiation within 8 weeks (HR 9–10 weeks 1.4 (1.21–1.68); HR 11–12 weeks 1.3 (1.06–1.59); HR 13–16 weeks 1.7 (1.23–2.23)).ConclusionOur data support initiating adjuvant chemotherapy in stage III colon cancer patients within 8 weeks post-surgery.