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dc.creatorLu Y.
dc.creatorGehr A.W.
dc.creatorMeadows R.J.
dc.creatorGhabach B.
dc.creatorNeerukonda L.
dc.creatorNarra K.
dc.creatorOjha R.P.
dc.date.accessioned2022-09-28T17:57:03Z
dc.date.available2022-09-28T17:57:03Z
dc.date.issued2022
dc.identifier.urihttps://doi.org/10.1186/s12885-022-09688-w
dc.identifier.urihttps://repository.tcu.edu/handle/116099117/55834
dc.description.abstractBackground: Prior studies reported survival benefits from early initiation of adjuvant chemotherapy for stage III colon cancer, but this evidence was derived from studies that may be sensitive to time-related biases. Therefore, we aimed to estimate the effect of initiating adjuvant chemotherapy ?8 or ? 12 weeks on overall and disease-free survival among stage III colon cancer patients using a study design that helps address time-related biases. Methods: We used institutional registry data from JPS Oncology and Infusion Center, a Comprehensive Community Cancer Program. Eligible patients were adults aged < 80 years, diagnosed with first primary stage III colon cancer between 2011 and 2017, and received surgical resection with curative intent. We emulated a target trial with sequential eligibility. We subsequently pooled the trials and estimated risk ratios (RRs) along with 95% confidence limits (CL) for all-cause mortality and recurrence or death at 5-years between initiators and non-initiators of adjuvant chemotherapy ?8 or ? 12 weeks using pseudo-observations and a marginal structural model with stabilized inverse probability of treatment weights. Results: Our study population comprised 222 (for assessing initiation ?8 weeks) and 310 (for assessing initiation ?12 weeks) observations, of whom the majority were racial/ethnic minorities (64–65%), or uninsured with or without enrollment in our hospital-based medical assistance program (68–71%). Initiation of adjuvant chemotherapy ?8 weeks of surgical resection did not improve overall survival (RR for all-cause mortality = 1.04, 95% CL: 0.57, 1.92) or disease-free survival (RR for recurrence or death = 1.07, 95% CL: 0.61, 1.88). The results were similar for initiation of adjuvant chemotherapy ?12 weeks of surgical resection. Conclusions: Our results suggest that the overall and disease-free survival benefits of initiating adjuvant chemotherapy ?8 or ? 12 weeks of surgical resection may be overestimated in prior studies, which may be attributable to time-related biases. Nevertheless, our estimates were imprecise and differences in population characteristics are an alternate explanation. Additional studies that address time-related biases are needed to clarify our findings. © 2022, The Author(s).
dc.languageen
dc.publisherSpringerNature
dc.rightsThe Author(s) 2022
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.sourceBMC Cancer
dc.subjectAdjuvant chemotherapy
dc.subjectcolon cancer
dc.subjectDisease-free survival
dc.subjectMortality
dc.subjectPrognosis
dc.subjectQuality of care
dc.subjectTiming
dc.titleTiming of adjuvant chemotherapy initiation and mortality among colon cancer patients at a safety-net health system
dc.typeArticle
dc.rights.licenseCC BY 4.0
local.collegeBurnett School of Medicine
local.departmentBurnett School of Medicine
local.personsMeadows (SOM), Ojha (SOM)


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