Objective:To evaluate stage III colon cancer patients discussed at a multidisciplinary team meeting (MDT) to identify reasons for clinicians not recommending adjuvant chemotherapy and reasons for patients declining recommended chemotherapy.Design: Retrospective cohort study.Setting:Regional cancer centre (RCC) in southern Queensland servicing a population of 300 000.Participants:Surgically managed stage III colon cancer patients diagnosed at Toowoomba Hospital between July 2010 and December 2014.Main Outcome Measures:Reasons why adjuvant chemotherapy was not recommended by the MDT or following referral to a medical oncologist, and patients’ reasons for refusing chemotherapy despite medical oncology recommendation were determined.Results:One hundred and nine patients were suitable for evaluation. Overall, 72 (66.1%) received adjuvant chemotherapy. Chemotherapy was not recommended in 25 (23.4%) of patients, with the majority (68%) having more than one cited reason. The presence of multiple comorbidities and advanced age were the most common reasons for non-recommendation (p = <0.01). Age alone was not a reason for not recommending chemotherapy. Twelve (11%) patients declined offered chemotherapy. Reasons for refusal were not detailed in the majority of patient charts (63.6%). Travel distance was not a factor in accepting or refusing chemotherapy.Conclusion:Discussion at an MDT facilitates the identification of patients unsuitable for adjuvant treatment. Reasons for declining offered chemotherapy need to be assessed fully to ensure that patient’s treatment preferences are balanced against the proven benefits of chemotherapy. Attendance at a RCC provides the opportunity for high standard care in the management of stage III colon cancer.