Referral Patterns and Adjuvant Chemotherapy Use in Patients With Stage II Colon Cancer

Background: Little is known about the actual rate of use of adjuvant chemotherapy in stage II colon cancer and about referral patterns that give patients access to this treatment. Patients and Methods: We searched the tumor registry at Baylor University Medical Center at Dallas to identify patients with stage II colon cancer who underwent resection between 1995 and 2003. The rates of referral to medical oncology and adjuvant chemotherapy use were calculated and potential predictive variables were analyzed using univariate and multivariate techniques. Results: We identified 287 patients with stage II colon cancer. A total of 160 patients (56%) were referred to a medical oncologist. Eighty patients (28%) received adjuvant chemotherapy. Age < 50 years, private insurance status, lower comorbidity score, higher T stage, and poor tumor differentiation were significant predictors of adjuvant chemotherapy use (P <= .05). Conclusion: Variability and controversy exist over the use of adjuvant chemotherapy in patients with stage II colon cancer. Our study suggests many patients are not referred to a medical oncologist and may not be fully informed of all treatment options. Referral patterns become more important as a better understanding of recurrence risk is achieved and patient selection for adjuvant chemotherapy is optimized.