Time to treatment predictive for survival in colorectal cancer
Biagi JJ. JAMA. 2011;305:2335-2342.
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A 4-week interval from diagnosis to the initiation of treatment with adjuvant chemotherapy resulted in poorer OS and DFS for patients with colorectal cancer, according to study results published in the Journal of the American Medical Association.
“Our results demonstrate a significant adverse association between time to adjuvant chemotherapy and survival in colorectal cancer, supporting a position that clinicians and jurisdictions need to optimize patient flow logistics to minimize time to adjuvant chemotherapy,” the researchers wrote. “The results also suggest that the timing of chemotherapy may need to be more strictly controlled as a variable in future adjuvant trials.”
In a meta-analysis of 198 articles published from 1975 to January 2011, researchers found 10 studies in which all patients were treated with adjuvant chemotherapy. There was a documented and clearly defined measure of time from surgery to initiation of treatment, and the relationship between time from surgery to initiation of treatment and patient outcomes in colorectal cancers was recorded.
The 10 reviewed studies included 15,410 patients. Patients were evaluable for OS in all 10 studies and for DFS in six studies. Nine studies were cohort- or population-based, and one study was a secondary analysis from a randomized trial of chemotherapy.
Researchers determined that a 4-week delay in time to adjuvant chemotherapy was associated with a significant decrease in both OS (HR=1.14; 95% CI, 1.10-1.17) and DFS (HR=1.14; 95% CI, 1.10-1.18). There was no significant heterogeneity among included studies.
Researchers said the results remained significant, even after adjusting for potential publication bias and when the analysis was repeated to exclude studies of largest weight.
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