The Impact of Complications on Colorectal Cancer Care

Colorectal cancer (CRC) is diagnosed in almost 150,000 patients in the United States each year and is the second leading cause of cancer-related death, accounting for more than 50,000 mortalities annually. The use of adjuvant chemotherapy has been a key quality measure for stage III CRC care because it is associated with a significant survival benefit. Chemotherapy for these patients has been shown to improve survival by as much as 16% after 5 years. However, national data indicate that guideline-recommended care is not provided to many patients. Studies have shown that the rates of adjuvant chemotherapy use for stage III CRC range from only 39% to 71%. Few studies have shed light on the reasons for the underuse of adjuvant chemotherapy in stage III CRC. Some sociodemographic variables (eg, older age, minority ethnicity, and lower socioeconomic status) have been linked to the omission of chemotherapy. However, it’s likely that other clinical predictors— including comorbid diseases, patients opting out of chemotherapy, and the high prevalence of perioperative complications in colorectal surgery—play a role in the receipt of chemotherapy. There may also be physician reluctance to give chemotherapy to patients who are frail or too sick from their surgical recovery. Complications in Colorectal Cancer Surgery In the December 2010 issue of Diseases of the Colon & Rectum, my colleagues and I published a study that examined the extent to which surgical complications are associated with the omission of recommended chemotherapy for CRC patients. We looked at data from 17,108 patients who had surgery for stage III CRC using patients from the Surveillance, Epidemiology, and End Results-Medicare database. Our results showed that at least...