Socioeconomic and geographic variation in adjuvant chemotherapy among elderly patients with stage III colon cancer in Norway – a national register-based cohort study
Abstract Background About half of the patients diagnosed with colon cancer are 70 years or older. Standard treatment for stage III colon cancer is major surgical resection followed by adjuvant chemotherapy (ACT). Norwegian guidelines recommend initiation of ACT within 6 weeks after resection. Object...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Springer
2024-12-01
|
| Series: | Research in Health Services & Regions |
| Subjects: | |
| Online Access: | https://doi.org/10.1007/s43999-024-00057-7 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846112828127182848 |
|---|---|
| author | Elin Marthinussen Gustavsen Stig Norderval Liv Marit Dørum Aina Balto Ragnhild Heimdal Barthold Vonen Eva Stensland Ellinor Haukland Beate Hauglann |
| author_facet | Elin Marthinussen Gustavsen Stig Norderval Liv Marit Dørum Aina Balto Ragnhild Heimdal Barthold Vonen Eva Stensland Ellinor Haukland Beate Hauglann |
| author_sort | Elin Marthinussen Gustavsen |
| collection | DOAJ |
| description | Abstract Background About half of the patients diagnosed with colon cancer are 70 years or older. Standard treatment for stage III colon cancer is major surgical resection followed by adjuvant chemotherapy (ACT). Norwegian guidelines recommend initiation of ACT within 6 weeks after resection. Objective This study investigated socioeconomic and geographic variation in the recommended provision of ACT to elderly patients with stage III colon cancer in Norway. Methods This population-based retrospective cohort study included patients aged 70 years or older diagnosed with stage III colon cancer between 2011 and 2021 who underwent major surgical resection. Individual data were obtained from national registries. Multilevel logistic regression analysis was used to model variation in provision of ACT. Results Of 4 501 included patients, 603 (13%) and 1 182 (26%) received ACT within 6 and 8 weeks after resection, respectively. The provision of ACT decreased with increasing age and frailty. Odds of ACT within 6 weeks decreased for patients with low socioeconomic status (SES) compared to high SES (odds ratio (OR) 0.67 (95% confidence interval (CI) 0.50–0.91)), and decreased for patients living alone compared to those living with a cohabitant (OR 0.72 (95% CI 0.58–0.91)). Geographic variation was found between hospital referral areas (OR 0.41–2.58). Conclusions Our study found that ACT provision to elderly stage III colon cancer patients is associated with SES and geography, indicating variation in guidelines adherence. Further research is needed to explore the impact of ACT timing among elderly patients with stage III colon cancer in Norway. |
| format | Article |
| id | doaj-art-1dd9851d7c564ca4a86916742f960f3c |
| institution | Kabale University |
| issn | 2730-9827 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Springer |
| record_format | Article |
| series | Research in Health Services & Regions |
| spelling | doaj-art-1dd9851d7c564ca4a86916742f960f3c2024-12-22T12:15:58ZengSpringerResearch in Health Services & Regions2730-98272024-12-013111210.1007/s43999-024-00057-7Socioeconomic and geographic variation in adjuvant chemotherapy among elderly patients with stage III colon cancer in Norway – a national register-based cohort studyElin Marthinussen Gustavsen0Stig Norderval1Liv Marit Dørum2Aina Balto3Ragnhild Heimdal4Barthold Vonen5Eva Stensland6Ellinor Haukland7Beate Hauglann8Department of Community Medicine, The Arctic University of Norway (UiT)Department of Gastrointestinal Surgery, University Hospital of Northern NorwayCancer Registry of Norway, Norwegian Institute of Public HealthCancer Registry of Norway, Norwegian Institute of Public HealthGeriatric Department, Akershus University HospitalNorthern Norway Regional Health AuthorityDepartment of Community Medicine, The Arctic University of Norway (UiT)Department of Oncology and Palliative Medicine, Nordland HospitalCentre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health AuthorityAbstract Background About half of the patients diagnosed with colon cancer are 70 years or older. Standard treatment for stage III colon cancer is major surgical resection followed by adjuvant chemotherapy (ACT). Norwegian guidelines recommend initiation of ACT within 6 weeks after resection. Objective This study investigated socioeconomic and geographic variation in the recommended provision of ACT to elderly patients with stage III colon cancer in Norway. Methods This population-based retrospective cohort study included patients aged 70 years or older diagnosed with stage III colon cancer between 2011 and 2021 who underwent major surgical resection. Individual data were obtained from national registries. Multilevel logistic regression analysis was used to model variation in provision of ACT. Results Of 4 501 included patients, 603 (13%) and 1 182 (26%) received ACT within 6 and 8 weeks after resection, respectively. The provision of ACT decreased with increasing age and frailty. Odds of ACT within 6 weeks decreased for patients with low socioeconomic status (SES) compared to high SES (odds ratio (OR) 0.67 (95% confidence interval (CI) 0.50–0.91)), and decreased for patients living alone compared to those living with a cohabitant (OR 0.72 (95% CI 0.58–0.91)). Geographic variation was found between hospital referral areas (OR 0.41–2.58). Conclusions Our study found that ACT provision to elderly stage III colon cancer patients is associated with SES and geography, indicating variation in guidelines adherence. Further research is needed to explore the impact of ACT timing among elderly patients with stage III colon cancer in Norway.https://doi.org/10.1007/s43999-024-00057-7Socioeconomic variationGeographic variationColon cancerAdjuvant chemotherapyElderlyHealth care utilisation |
| spellingShingle | Elin Marthinussen Gustavsen Stig Norderval Liv Marit Dørum Aina Balto Ragnhild Heimdal Barthold Vonen Eva Stensland Ellinor Haukland Beate Hauglann Socioeconomic and geographic variation in adjuvant chemotherapy among elderly patients with stage III colon cancer in Norway – a national register-based cohort study Research in Health Services & Regions Socioeconomic variation Geographic variation Colon cancer Adjuvant chemotherapy Elderly Health care utilisation |
| title | Socioeconomic and geographic variation in adjuvant chemotherapy among elderly patients with stage III colon cancer in Norway – a national register-based cohort study |
| title_full | Socioeconomic and geographic variation in adjuvant chemotherapy among elderly patients with stage III colon cancer in Norway – a national register-based cohort study |
| title_fullStr | Socioeconomic and geographic variation in adjuvant chemotherapy among elderly patients with stage III colon cancer in Norway – a national register-based cohort study |
| title_full_unstemmed | Socioeconomic and geographic variation in adjuvant chemotherapy among elderly patients with stage III colon cancer in Norway – a national register-based cohort study |
| title_short | Socioeconomic and geographic variation in adjuvant chemotherapy among elderly patients with stage III colon cancer in Norway – a national register-based cohort study |
| title_sort | socioeconomic and geographic variation in adjuvant chemotherapy among elderly patients with stage iii colon cancer in norway a national register based cohort study |
| topic | Socioeconomic variation Geographic variation Colon cancer Adjuvant chemotherapy Elderly Health care utilisation |
| url | https://doi.org/10.1007/s43999-024-00057-7 |
| work_keys_str_mv | AT elinmarthinussengustavsen socioeconomicandgeographicvariationinadjuvantchemotherapyamongelderlypatientswithstageiiicoloncancerinnorwayanationalregisterbasedcohortstudy AT stignorderval socioeconomicandgeographicvariationinadjuvantchemotherapyamongelderlypatientswithstageiiicoloncancerinnorwayanationalregisterbasedcohortstudy AT livmaritdørum socioeconomicandgeographicvariationinadjuvantchemotherapyamongelderlypatientswithstageiiicoloncancerinnorwayanationalregisterbasedcohortstudy AT ainabalto socioeconomicandgeographicvariationinadjuvantchemotherapyamongelderlypatientswithstageiiicoloncancerinnorwayanationalregisterbasedcohortstudy AT ragnhildheimdal socioeconomicandgeographicvariationinadjuvantchemotherapyamongelderlypatientswithstageiiicoloncancerinnorwayanationalregisterbasedcohortstudy AT bartholdvonen socioeconomicandgeographicvariationinadjuvantchemotherapyamongelderlypatientswithstageiiicoloncancerinnorwayanationalregisterbasedcohortstudy AT evastensland socioeconomicandgeographicvariationinadjuvantchemotherapyamongelderlypatientswithstageiiicoloncancerinnorwayanationalregisterbasedcohortstudy AT ellinorhaukland socioeconomicandgeographicvariationinadjuvantchemotherapyamongelderlypatientswithstageiiicoloncancerinnorwayanationalregisterbasedcohortstudy AT beatehauglann socioeconomicandgeographicvariationinadjuvantchemotherapyamongelderlypatientswithstageiiicoloncancerinnorwayanationalregisterbasedcohortstudy |