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Mari GM, Maggioni D, Crippa J, Costanzi ATM, Scotti MA, Giardini V, Garancini M, Cocozza E, Borroni G, Benzoni I, Martinotti M, Totaro L, Origi M, Mazzola M, Ferrari G, Achilli P, Ziccarelli A, Martino A, Petri R, Botta F, Bagnardi V, Pugliese G, Forgione A, Pugliese R. Compliance to Adjuvant Chemotherapy of Patients Who Underwent Surgery for Rectal Cancer: Report from a Multi-institutional Research Network. World J Surg 2019; 43:2544-2551. [PMID: 31240433 DOI: 10.1007/s00268-019-05060-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Adjuvant chemotherapy for locally advanced rectal cancer is associated with improved overall survival. However, recent evidence from randomized trials showed a compliance rate of 43 to 73%, which may affect efficacy. The aim of this multicenter retrospective analysis was to investigate the compliance rate to adjuvant treatment for patients who underwent rectal surgery for cancer. METHODS Patients who underwent surgery with curative intent for rectal cancer in six Italian colorectal centers between January 2013 and December 2017 were retrospectively reviewed. Exclusion criteria were age less than 18 years, palliative or emergency surgery, and stage IV disease. Parameters of interest were patients' characteristics, preoperative tumor stage, neo-adjuvant chemoradiation therapy, intra-operative and postoperative outcomes. Although the participating centers referred to the same treatment guidelines for treatment, the chemotherapy regiment was not standardized across the institutions. Reasons for not starting adjuvant chemotherapy when indicated, interruption, and modification of drug regimen were collected to investigate compliance. RESULTS A total of 572 patients were included in the analysis. Two hundred and fifty-two (44.1%) patients received neo-adjuvant chemoradiation therapy. All patients underwent high anterior rectal resection, low anterior rectal resection, or Miles' procedure. Of 399 patients with an indication to adjuvant chemotherapy, 176 (44.1%) completed the treatment as planned. Compliance for patients who started chemotherapy was 56% (95% CI 50.4-61.6%). Sixty-six patients interrupted the treatment, 76 patients significantly reduced the drug dose, and 41 patients had to switch to other therapeutic regimens. CONCLUSIONS The present multicenter investigation reports a low compliance rate to adjuvant chemotherapy after rectal resection for cancer. Multidisciplinary teams should focus on future effort to improve compliance for these patients.
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Affiliation(s)
- Giulio M Mari
- General Surgery Department, Desio Hospital, ASST Monza, Desio, MB, Italy
| | - Dario Maggioni
- General Surgery Department, Desio Hospital, ASST Monza, Desio, MB, Italy
| | - Jacopo Crippa
- General Surgery Residency Program, University of Milan, Via Festa del Perdono, 7, 20100, Milan, Italy.
| | | | - Mauro A Scotti
- General Surgery Department, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Vittorio Giardini
- General Surgery Department, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Mattia Garancini
- General Surgery Department, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Eugenio Cocozza
- General Surgery Department, Varese Hospital, ASST Settelaghi, Varèse, Italy
| | - Giacomo Borroni
- General Surgery Department, Varese Hospital, ASST Settelaghi, Varèse, Italy
| | - Ilaria Benzoni
- Department of Surgery, Cremona Hospital, ASST Istituti Ospitalieri Cremona, Cremona, Italy
| | - Mario Martinotti
- Department of Surgery, Cremona Hospital, ASST Istituti Ospitalieri Cremona, Cremona, Italy
| | - Luigi Totaro
- Department of Surgery, Cremona Hospital, ASST Istituti Ospitalieri Cremona, Cremona, Italy
| | - Matteo Origi
- General Surgery Department, Niguarda Hospital, ASST Grande ospedale metropolitano Niguarda, Milan, Italy
| | - Michele Mazzola
- General Surgery Department, Niguarda Hospital, ASST Grande ospedale metropolitano Niguarda, Milan, Italy
| | - Giovanni Ferrari
- General Surgery Department, Niguarda Hospital, ASST Grande ospedale metropolitano Niguarda, Milan, Italy
| | - Pietro Achilli
- General Surgery Department, Niguarda Hospital, ASST Grande ospedale metropolitano Niguarda, Milan, Italy
| | | | - Antonio Martino
- General Surgery Department, AOU "SSMM della Misericordia", Udine, Italy
| | - Roberto Petri
- General Surgery Department, AOU "SSMM della Misericordia", Udine, Italy
| | - Francesca Botta
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | | | - Antonello Forgione
- General Surgery Department, Niguarda Hospital, ASST Grande ospedale metropolitano Niguarda, Milan, Italy
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