Who gets adjuvant treatment for stage II and III rectal cancer? Insight from surveillance, epidemiology, and end results-medicare Journal Article

Authors: Schrag, D.; Gelfand, S. E.; Bach, P. B.; Guillem, J.; Minsky, B. D.; Begg, C. B.
Article Title: Who gets adjuvant treatment for stage II and III rectal cancer? Insight from surveillance, epidemiology, and end results-medicare
Abstract: Purpose: To examine the relationship between patient characteristics and the use of adjuvant pelvic radiation with and without chemotherapy among patients aged 65 years and older with stage II and III rectal cancer. Patients and Methods: A retrospective cohort study using the Surveillance, Epidemiology, and End Results-Medicare linked database identified 1,411 patients aged 65 and older with resected stage II and III rectal cancers diagnosed between 1992 and 1996. From claims submitted to Medicare, we measured the use of pelvic radiation therapy with or without chemotherapy and pre- or postoperatively. Results: Fifty-seven percent of patients received radiation, 42% received chemotherapy and radiation, and 7% had treatment delivered preoperatively. Age was the strongest determinant of treatment: 73% of patients aged 65 to 69, 66% aged 70 to 75, 52% aged 75 to 79, 39% aged 80 to 84, and 21% aged 85 to 89 received radiation. The age trend remained strong after adjusting for other factors that predict receipt of treatment and after exclusion of patients with any evident comorbidity (P < .001). Patients were more likely to receive radiation treatment if they had an abdominal perineal resection, stage III disease, or a T4 tumor. Conclusion: Because pelvic recurrences are a substantial cause of morbidity, further efforts are needed to ensure that elderly patients have the opportunity to make informed decisions regarding adjuvant treatment. © 2001 by American Society of Clinical Oncology.
Keywords: controlled study; treatment outcome; aged; aged, 80 and over; retrospective studies; major clinical study; fluorouracil; patient selection; antineoplastic agents; united states; cancer adjuvant therapy; cancer radiotherapy; postoperative care; preoperative care; radiotherapy, adjuvant; cancer staging; antineoplastic agent; physician's practice patterns; treatment indication; cohort studies; cohort analysis; age factors; retrospective study; age; medicare; folinic acid; comorbidity; cancer epidemiology; abdominal surgery; regression analysis; floxuridine; analysis of variance; rectal neoplasms; rectum cancer; humans; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 19
Issue: 17
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2001-09-01
Start Page: 3712
End Page: 3718
Language: English
PUBMED: 11533092
PROVIDER: scopus
Notes: Export Date: 21 May 2015 -- Source: Scopus