Re: Completion of Therapy by Medicare Patients With Stage III Colon Cancer

Extract

We read with interest the article by Dobie et al. ( 1 ) . These investigators linked data from the Surveillance, Epidemiology, and End Results program to Medicare claims and attempted to address the important questions: what percentage of patients in routine clinical practice fail to complete adjuvant treatment for stage III colon cancer and what are the associated factors? However, as the authors acknowledge, their study was limited to patients who were older than 65 years, and it contained multiple assumptions, liberal definitions, and arbitrary classification—largely because they had no data (other than episodes of chemotherapy) beyond the initial patient contact.

Our prospective comprehensive colorectal cancer database contained 1347 patients who were entered during the 8-year period from January 1, 1998, through December 31, 2005, including 274 patients with stage III colon cancer (153 men and 121 women). We have complete data on the management of individual patients after diagnosis ( Table 1 ), with patients receiving adjuvant 5-fluorouracil–based chemotherapy, according to standard protocols. To our knowledge, this correspondence is the first documentation of both physician-related factors and patient decision making in this context and their influence on the percentage of patients starting adjuvant chemotherapy and finishing all adjuvant chemotherapy treatments.