In Reply We thank Gordan and Diaz as well as Gelibter et al for their comments. We agree that the lack of cancer-specific mortality is a limitation, as discussed in our article. We also agree that information on dose and timing of chemotherapy, molecular data, surgery quality, and adherence to standard care guidelines could have added value to the study. However, this study was based on cancer registry and medical claims data for surveillance and billing purposes. There are challenges in using such data, such as availability, completeness, composition, and standardization of data for research. Surgery quality and molecular data are usually unavailable in data for surveillance and billing. In addition, oncologists in our system might not refer to molecular data in their practice, especially for the study period, and to our knowledge, whether the prevalence of molecular biomarkers varies by age is not well known.1 Thus, our results might not be influenced by molecular characteristics. Our data did not have sufficient information to determine, standardize, and integrate precise dosing from various chemotherapy drugs.
Zhu K, Manjelievskaia J, Shriver CD. Use of Adjuvant Chemotherapy After Surgery in Patients With Colon Cancer—Reply. JAMA Surg. 2017;152(9):895–896. doi:10.1001/jamasurg.2017.1618
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