Patient factors related to the real-world adoption of 3 months of adjuvant chemotherapy (ACT) in patients with stage III colorectal cancer (CRC).
Bibliographic record
Abstract
e15609 Background: Based on the IDEA analysis, 3 months (mos) of ACT with CAPOX is an option for both low-risk and high-risk stage III CRC, with potential resource utilization, cost and toxicity benefits. This study examined the patterns of uptake of CAPOX vs FOLFOX and duration of ACT, focussing on patient factors, in a contemporary post-COVID real-world cohort of patients (pts) in British Columbia, Canada. Methods: The provincial pharmacy database was used to identify pts with resected stage III CRC who received adjuvant CAPOX or FOLFOX from January 2021 to December 2022. Demographic, tumor, and treatment information was collected. Descriptive statistical analyses were performed to examine baseline characteristics and Fisher’s exact test was used to examine univariate associations. Results: 452 pts were included, of which 234 (52%) and 218 (48%) were planned to receive 3 and 6 mos of ACT respectively (see table). Within the 3 mos group, 226 (97%) received CAPOX. Within the 6 mos group, there was a 51%/49% split between CAPOX/FOLFOX. By univariate analysis, age > 70y (P = 0.039), low/intermediate grade (P = 0.005) and low-risk disease (P < 0.0001) were significantly associated with 3 mos of CAPOX. There was no difference in ACT choice with regards to ECOG status, ileostomy or pre-existing neuropathy. 29% of pts planned for 6 mos of ACT had low-risk disease, with 52% of these receiving CAPOX. Patients who received 6mos of ACT were significantly more likely to report neuropathy (68 vs 36%, P < 0.0001) and to stop oxaliplatin early (54 vs 31%, P < 0.0001). The most likely reason for early discontinuation of ACT was neuropathy in the 6mos group and gastrointestinal toxicity in the 3mos group (P < 0.0001). Irrespective of duration, mean time from consult to ACT was longer for FOLFOX vs CAPOX (24 vs 19 days, P = 0.007). Conclusions: In this contemporary cohort, use of 3 mos of adjuvant CAPOX remains low. 6 mos of oxaliplatin is still being offered to pts with low-risk disease, and is associated with more neuropathy warranting early oxaliplatin cessation. Exploration of patient preferences and resource costs may improve more widespread adoption of 3 mos of adjuvant CAPOX in stage III CRC. [Table: see text]
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".