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Following colorectal cancer surgery, longer delay before chemotherapy associated with worse survival
Date:6/4/2011

rogeneity (lack of uniformity) among included studies. Results remained significant after adjustment for potential publication bias and when the analysis was repeated to exclude studies of largest weight.

"The effect of AC on survival is thought to be eradication of micro-metastatic deposits in a proportion of patients who would otherwise be destined to have cancer recurrence. There is a substantial theoretical rationale to initiate AC promptly after curative surgery," the authors write.

Regarding the question of after what time period would beginning chemotherapy appear to be of limited benefit, the authors found that their results indicate survival of 48 percent if chemotherapy is administered at 12 weeks instead of 4 weeks, suggesting there may be some benefit to chemotherapy beyond a 12-week window, and that a reasonable limit may be more in the order of 4 to 5 months.

These findings suggest that timing of AC plays a critical role in the management and outcomes of patients with CRC and that it would be prudent for clinicians and jurisdictions to avoid delays in access to chemotherapy, the researchers write. "Our results indicate that at a population level, the effect of delays might be substantial. With approximately 140,000 new cases of CRC diagnosed in the United States in 2009, of which roughly 35 percent or 49,000 had stage III disease, the population at risk is sizeable."

"In conclusion, our results demonstrate a significant adverse association between time to AC and survival in CRC, supporting a position that clinicians and jurisdictions need to optimize patient flow logistics to minimize time to AC," the authors write. "Our results provide further validation of the intuitive concept of early time to AC. Physicians may need to more carefully consider timing when discussing AC with patients."


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Contact: Christina Archibald
christina.archibald@queensu.ca
613-533-2877
JAMA and Archives Journals
Source:Eurekalert

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