Practice Patterns and Health Outcomes of Adjuvant Oxaliplatin Chemotherapy for Colorectal Cancer
Bibliographic record
Abstract
INTRODUCTION: Oxaliplatin-containing adjuvant chemotherapy improves survival for stage III colon cancer. Yet it is not without harms, most commonly dose-dependent peripheral neuropathy. The 2018 International Duration Evaluation of Adjuvant Chemotherapy (IDEA) trial sought to determine the optimal duration of adjuvant therapy by evaluating the non-inferiority (NI) of 3 versus 6 months of treatment. The 3-year disease-free survival probability was 74.6% in the 3-month group versus 75.5% in the 6-month group (HR 1.07, 95% CI 1.00-1.15; pNI = 0.11). There remain open questions regarding how these findings changed practice, whether these outcomes are obtained in the general population, and – given oxaliplatin-induced neuropathy – the relationship between treatment duration and post-treatment falls. METHODS: We leveraged linked administrative and population-based datasets held at ICES to conduct three retrospective cohort studies of patients with stage III colon cancer in Ontario, Canada. First, we employed interrupted time series regression and mixed models to evaluate the association between IDEA’s publication and prescribed treatment durations. Second, we utilized overlap propensity score-weighted survival models to determine the relationship between treatment duration and mortality. Third, we again used weighted survival models to examine the association between treatment duration and fall-related injury. RESULTS: IDEA’s publication was associated with a 16.4% (95% CI 12.5-20.3%) absolute increase in patients treated with ≤50% of a 6-month course of therapy. Between-prescriber variation strongly influenced treatment duration in the post-IDEA period (median odds ratio 2.10 [95% CI 1.73-3.18] for short-duration treatment). Treatment with 50% of a 6-month course of therapy was associated with a HR of 1.13 (95% CI 0.88-1.47) for overall mortality versus >85% of a 6-month course of therapy. Meanwhile, treatment with >85% of a 6-month course of therapy conferred a HR of 0.84 (95% CI 0.62-1.13) for fall-related injury. CONCLUSION: Although IDEA could not conclude non-inferiority of 3 to 6 months of adjuvant therapy, the trial rapidly shifted clinical practice while introducing greater provider-level practice variation. While intuitive concerns about the relationship between oxaliplatin and fall-related injury are not borne out in the data, evidence from routine practice solidifies that treatment duration is a preference-sensitive decision involving a tradeoff between survival and toxicity.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.002 | 0.028 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| 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".