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. 2016;4(1):103-116.
doi: 10.1007/s40487-016-0020-4. Epub 2016 May 11.

Factors Impacting Treatment Choice in the First-Line Treatment of Colorectal Cancer

Lourens T Bloem  1 , Richard De Abreu Lourenço  2 , Melvin Chin  3 , Brett Ly  3 , Marion Haas  2
Affiliations

Factors Impacting Treatment Choice in the First-Line Treatment of Colorectal Cancer

Lourens T Bloem et al. Oncol Ther. 2016.

Abstract

Introduction: To investigate the factors that affect the choice of 5-fluorouracil (5-FU) or its oral alternative, capecitabine, as first-line treatment in patients with colorectal cancer (CRC).

Methods: Patients treated with 5-FU or capecitabine for CRC between January 1, 2011 and December 31, 2013 in a teaching hospital in the Sydney metropolitan area, Australia were identified using the hospital's database MOSAIQ®. The electronic medical record of each patient was manually reviewed to extract factors potentially affecting treatment choice. Logistic regression was used to assess which patient and/or treatment factors could explain the choice between 5-FU or capecitabine. Where it was available in the medical correspondence, the explicit reason for the choice made was extracted.

Results: 170 CRC patients were included; 119 on 5-FU, and 51 on capecitabine. The odds of receiving capecitabine as a first-line treatment were positively associated with giving patients a choice in the decision (OR = 17.51, 95% CI: 5.37-57.08). Qualitative data suggest treatment choices were motivated by convenience (oral administration) and tolerability. Time from diagnosis to treatment commencement (OR = 1.02 per month, 95% CI 1.00-1.04) was also found to be positively associated with the choice of capecitabine. The odds of being treated with capecitabine were lower for patients who lived further from the treating hospital (OR = 0.22, 95% CI 0.05-0.94).

Conclusion: This study suggests that patient choice, favoring oral capecitabine over i.v. 5-FU, was a key factor influencing first-line treatment for CRC in this cohort. To respect their autonomy, patients should be involved in the clinical decision making process.

Keywords: Colorectal cancer; Mode of administration; Patient involvement; Treatment choice.

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Conflict of interest statement

M Chin has received conference travel support from Boehringer Ingelheim, Lilly, Novartis, Bristol Myer Squibb and Pfizer. L Bloem, B Ly, M Haas and R De Abreu Lourenco have no conflicts of interest to declare. This article is based on previously treated patients and does not involve any new studies of human or animal subjects performed by any of the authors. Ethics approval for this study was obtained from the South Eastern Sydney Local Health District Human Research Ethics Committee (13/288) and ratified by the University of Technology Sydney Human Research Ethics Committee (2014000002).

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