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Treatment and Referral Patterns for Colorectal Cancer

Background:National guidelines recommend adjuvant chemotherapy for colorectal cancer stages III, and IV; however, it has been shown that only 45–55% of these patients receive chemotherapy. Objectives:We sought to describe treatment patterns for patients diagnosed with colorectal cancer and to examine the reasons why patients do not receive chemotherapy. Research Design:This was a retrospective cohort study. Setting and Patients:Patients included newly diagnosed cases of colorectal cancer at a health maintenance organization in central Massachusetts between January 1, 1997, and June 30, 1999. Main Outcome Measure:The main outcome measure was a referral or visit to an oncologist. Results:Sixty-six percent (n = 143) of the 217 colorectal cancer cases had a referral/visit to an oncologist or evidence of chemotherapy within 4 months of the index date. The referral rates by stage were: stage I, 47.7%; stage II, 59.5%; stage III, 87.1%; and stage IV, 66.7%. Of patients not referred with stage III disease, 4/8 were not referred because the treating physician did not recommend an oncology referral; patient refusal accounted for 3/8 (37.5%). The most commonly cited reason for lack of referral for stage IV patients was existing comorbidities or death. Younger age (<70 years) and stage III at diagnosis were significant predictors of oncology referral/visit. Conclusions:A substantial proportion of colorectal cancer patients are receiving appropriate referral for chemotherapy. This study is the first to elucidate reasons why patients do not receive chemotherapy and highlights both patient and physician factors.