Adjuvant chemotherapy for colon carcinoma with positive lymph nodes: use and benefit in routine health care practice

In 1990, an international consensus was reached on the efficacy of adjuvant chemotherapy for lymph node positive (stage III) colon carcinoma (CC). Thi s study evaluates the use and benefit of such therapy in routine health car e practice. The study includes all patients with stage III CC treated by pu tative curative surgery (n = 182) recorded at the Geneva cancer registry be tween 1990 and 1996. Factors modifying chemotherapy use were determined by logistic regression, considering patients with, chemotherapy as cases (n = 55) and others as controls (n = 127). The effect of chemotherapy on the 5-y ear survival was evaluated by the Cox model. Analyses were adjusted for pos sible confounders. The use of chemotherapy increased over the period (P-tre nd < 0.001). Age strongly modulated chemotherapy use. In 1996, 54% of eligi ble patients received chemotherapy, this proportion fell to 13% after age 7 0. Decisions to use chemotherapy significantly depended on stage, grade and cancer site. The chance to be treated was non-significantly lower among. i ndividuals of low social class, widowed and foreigners. Chemotherapy signif icantly decreased mortality rates (Hazard ratio: 0.35, 95%Cl: 0.18-0.68), i ndependently of the prognostic factors and with similar benefit regardless of stage and age group. Strong beneficial effect of adjuvant chemotherapy o n stage III CC can be achieved in routine practice. However, this study sho ws that it is probably not optimally utilised in Switzerland, particularly among the elderly. (C) 2001 Cancer Research Campaign.