Background:
Colorectal cancer (CRC) outcomes in regional and remote Australia are worse than in metropolitan areas. This may result from logistic difficulties, as the benefit of adjuvant chemotherapy diminishes with increased time from surgery. Intervals of 8 weeks or more between surgery and adjuvant chemotherapy have been shown to negate its impact. This study audited timeliness of postoperative referral to medical oncology,and initiation of chemotherapy for people diagnosed with CRC in the Dubbo catchment.
Methods:
A retrospective audit of patients with a diagnosis of CRC referred between November 2015 and February 2017 was undertaken. Descriptive statistics will be presented.
Results:
A total of 53 patients with CRC presenting to the Alan Coates Cancer Centre in Dubbo for consideration of neoadjuvant or adjuvant chemotherapy were identified. The median age was 70 years, and the average age was 68 years. 21/53 reported a residential address within the Dubbo postcode. 32/53 (60%) were male.
Of the 53 reviewed, 39 received chemotherapy. 4 patients declined chemotherapy when offered, and 10 patients were not offered chemotherapy.
Of the 31 patients undergoing adjuvant chemotherapy only, 18 had left sided colon cancers, 10 right sided colon cancers, 2 rectal cancers, and 1 a small bowel cancer.
All 8 of the patients who received neoadjuvant chemotherapy had rectal cancer. The median time from referral to first dose of neoadjuvant chemotherapy was 37 days.
In the 39 who underwent adjuvant chemotherapy, the median time from surgery to commencement of adjuvant chemotherapy was 56 days.
Conclusion:
The long duration between surgery and initiation of adjuvant chemotherapy in CRC may contribute to worse outcomes in rural and remote patients. There is a need to explore interventions to reduce these time intervals.