Final results from the OntarioNL COLON cancer treatment and outcome comparison

1

• Final results from the Ontario-NL COLON cancer
  treatment and outcome comparison
• 1999-2000
• Debrah Wirtzfeld MD, FRCSC, FACS
• Associate Professor of Surgery and Genetics
• Memorial University of Newfoundland

2
OBJECTIVES Colon Cancer treatment 1999-2000

• Detail concordance rates for adjuvant
  chemotherapy for surgically curable colon cancer
  (stages I-III)
• Explore concordance with guidelines for stage II
  colon cancer
• Discuss bias inherent in the Kaplan-Meier overall
  survival estimates

3
Total numbers consented
4
DemographicsNewfoundland Ontario

5
Adjuvant chemotherapy as a function of Stage
6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
Violations of Kaplan-Meier Survival Modelling

• 1) the survival probabilities are the same for
  subjects recruited early and late in the study
• 2) those patients who are censored will have the
  same survival as those who continue to be
  followed
• 3) that the event happens at the time specified

15
Conclusions

• Adjuvant chemotherapy use was concordant with
  guidelines in stage I and stage III colon cancer
• In stage II patients, high risk pathologic
  features were not consistently used
• Surgeon/GP - decision to refer to medical
  oncology
• Medical Oncology decision to administer
  adjuvant chemotherapy
• Bias introduced at several levels of the study
  questions the validity of the survival analysis

16
Acknowledgements

• Betty Dicks
• Pat Parfrey
• Bill Pollett
• Carol Negrijn
• Andrea Kavanagh
• Kevin Boyd

• crCIHRt for funding
• Elizabeth Oddone Paolucci
• Lynn Mikula
• Robert Gryfe
• Pietro Ravani
• Steve Gallinger

17
(No Transcript)