Reasons why clinicians do not recommend adjuvant chemotherapy
A recent study shows that discussion at a multidisciplinary meeting enables the identification of cancer patients unsuitable for adjuvant therapy.
Researchers argue that the reasons for refusing chemotherapy should be fully examined to make sure that treatment preferences of patients are balanced against the proven benefits of chemotherapy.
To determine reasons why clinicians do not recommend adjuvant chemotherapy and why patients decline recommended chemotherapy, a retrospective, single institution Australian study was conducted on all surgically managed stage III colon cancer patients diagnosed at the regional cancer centre at Toowoomba Hospital between July 2010 and December 2014.
Of the 109 patients suitable for evaluation, 72 (66.1 percent) received adjuvant chemotherapy. Clinicians did not recommend chemotherapy in 25 (23.4 percent) patients, with the majority (68 percent) having more than one cited reason.
The most common reasons for not recommending chemotherapy were multiple comorbidities and advanced age (p<0.01). Age alone was not a reason for nonrecommendation.
There were 12 (11 percent) patients who refused chemotherapy despite recommendation. Majority of patient charts (63.6 percent) did not elaborate the reasons for refusal. Travel distance did not count as a factor in accepting or declining chemotherapy.
“Attendance at a regional cancer centre provides the opportunity for high standard care in the management of stage III colon cancer,” researchers suggested.
These findings were similar to a 2012 study on surgically treated stage III colon cancer patients, which found that the most frequent reason for not recommending adjuvant chemotherapy was the presence of one or more comorbidities, or combination of comorbidity and age or frailty. [BMC Res Notes 2012;5:269]