Researchers from University of Kentucky Markey Cancer Center study have reported that many Kentucky patients with colon cancer are not receiving the recommended standard of care therapy for their disease. Their findings, ‘Nonadherence to Standard of Care for Locally Advanced Colon Cancer as a Contributory Factor for High Mortality Rates in Kentucky’, were published in the Journal of the American College of Surgeons.
Though the state has made great advances in colorectal cancer screening the past two decades, Kentucky continues to rank fifth in the nation for colorectal cancer mortality. Locally advanced colon cancers (LACC) – defined as colon cancers with high risk microscopic features or that have begun spreading via lymph nodes—are best treated with multiple modalities. The National Comprehensive Cancer Network practice guidelines recommend surgical removal of the tumour followed by adjuvant chemotherapy for stage IIb, IIc, and stage III colon cancers, which has greatly improved the survival of these patients.
For the study, the team wanted to determine the rate of nonadherence with current standard of care (SOC) and associated factors as possible contributors to mortality. They examined data for 1,404 Kentucky patients with LACC, gathered from the Kentucky Cancer Registry and insurance billing codes. Results showed that nearly 42% of these patients did not receive the full standard of care therapy, with the vast majority of patients failing to receive their adjuvant chemotherapy following a surgery. Among patients who did receive standard of care for colon cancer, the survival rate was 63%; for those who did not comply with standard of care, the survival rate dropped to 27% (p<0.0001).
Several independent risk factors were identified for those who did not receive standard of care, including patients age 65 and older, a high comorbidity index (i.e., other serious health issues), disability, Medicaid insurance status and a moderate to high poverty level.
Dr Avinash Bhakta, colorectal cancer surgeon with the UK Markey Cancer Center and lead author on the study, said the study highlights the importance of the adherence to standard of care for these patients.
"Many of these characteristics are shared by our Appalachian patient population, which is a vulnerable population here in Kentucky. With this knowledge, the UK Markey Cancer Center and its Affiliate Network are working on measures that will help increase access to standard of care therapies to this vulnerable population."