Chemotherapy use and patient treatment preferences in advanced colorectal cancer

A prospective cohort study

Authors

  • S. Yousuf Zafar MD, MHS,

    Corresponding author
    1. Duke Cancer Institute, Durham, North Carolina
    2. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
    • Duke Cancer Institute, DUMC 3505, Durham, NC 27710

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    • Fax: (919) 613-5228

  • Jennifer L. Malin MD, PhD,

    1. Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
    2. Division of Hematology and Medical Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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  • Steven C. Grambow PhD,

    1. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
    2. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
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  • David H. Abbott MS,

    1. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
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  • Jane T. Kolimaga MA,

    1. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
    2. Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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  • Leah L. Zullig MPH,

    1. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
    2. Department of Health Policy and Management, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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  • Jane C. Weeks MD,

    1. Department of Health Policy and Management, Dana Farber Cancer Institute, Boston, Massachusetts
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  • John Z. Ayanian MD,

    1. Department of Health Care Policy, Harvard Medical School, and Division of General Medicine, Brigham and Women's Hospital Boston, Massachusetts
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  • Katherine L. Kahn MD,

    1. RAND Corporation, Santa Monica, California
    2. Divisions of General Internal Medicine an d Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles, California
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  • Patricia A. Ganz MD,

    1. School of Public Health, University of California, Los Angeles, California
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  • Paul J. Catalano PhD,

    1. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
    2. Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
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  • Dee W. West PhD,

    1. Cancer Prevention Institute of California, Fremont, California
    2. Stanford School of Medicine, Stanford, California
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  • Dawn Provenzale MD,

    1. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
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  • for the Cancer Care Outcomes Research & Surveillance (CanCORS) Consortium

    1. Duke Cancer Institute, Durham, North Carolina
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  • The study sponsors played no role in study design, data collection, analysis, interpretation, writing, or the decision to submit for publication.

Abstract

BACKGROUND:

The objective of this study was to determine how patient preferences guide the course of palliative chemotherapy for advanced colorectal cancer.

METHODS:

Eligible patients with metastatic colorectal cancer (mCRC) were enrolled nationwide in a prospective, population-based cohort study. Data were obtained through medical record abstraction and patient surveys. Logistic regression analysis was used to evaluate patient characteristics associated with visiting medical oncology and receiving chemotherapy and patient characteristics, beliefs, and preferences associated with receiving >1 line of chemotherapy and receiving combination chemotherapy.

RESULTS:

Among 702 patients with mCRC, 91% consulted a medical oncologist; and among those, 82% received chemotherapy. Patients ages 65 to 75 years and aged ≥75 years were less likely to visit an oncologist, as were patients who were too sick to complete their own survey. In adjusted analyses, patients aged ≥75 years who had moderate or severe comorbidity were less likely to receive chemotherapy, as were patients who were too sick to complete their own survey. Patients received chemotherapy even if they believed that chemotherapy would not extend their life (90%) or that chemotherapy would not likely help with cancer-related problems (89%), or patients preferred treatment focusing on comfort even if it meant not living as long (90%). Older patients were less likely to receive combination first-line therapy. Patient preferences and beliefs were not associated with receipt of >1 line of chemotherapy or combination chemotherapy.

CONCLUSIONS:

The majority of patients received chemotherapy even if they expressed negative or marginal preferences or beliefs regarding chemotherapy. Patient preferences and beliefs were not associated with the intensity or number of chemotherapy regimens. Cancer 2013. © 2012 American Cancer Society.

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