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Nearly all patients (123/124) received adjuvant chemotherapy, although only 76 (61 percent) received oxaliplatin, a chemotherapeutic shown to extend the survival in this patient population.

"At first glance, this number looked low, but as we probed further, we found that all but 11 patients who didn't receive oxaliplatin had documented co-morbidities or other concerns that precluded them from receiving this treatment," explained O'Grady.

Thus, community medical oncologists were aware of data suggesting benefit of oxaliplatin, and documented reasoning for patients not receiving it. Whether elderly patients with stage III colon cancer are generally being undertreated requires further study.

The most common chemotherapy regimens administered were FOLFOX (54 percent), bolus 5-FU/LV (19 percent), and capecitabine (12 percent).

"Our audit also found a high rate of lymph node retrieval. This is critically important to medical oncology treatment planning," O'Grady said.

The records indicated that 74 percent of the patients had at least 12 lymph nodes retrieved. Nearly all patients (93 percent) received appropriate surveillance with history and physical exams at suggested intervals and routine CEA testing. Abdominal and pelvic surveillance CT was performed in 78 percent of patients.

"We found a drop off in compliance regarding the documentation of discussions between the doctor and patient about age and life expectancy in relation to adjuvant chemotherapy," said O'Grady. "This discussion is important and informs decision making."

Discussions about life expectancy and a patient's age were documented in only 49 percent of the cases.

"Further research sh
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