Age and adjuvant chemotherapy use after surgery for stage III colon cancer Journal Article
| Authors: | Schrag, D.; Cramer, L. D.; Bach, P. B.; Begg, C. B. |
| Article Title: | Age and adjuvant chemotherapy use after surgery for stage III colon cancer |
| Abstract: | Background: Randomized trials have established that 5-fluorouracil-based adjuvant chemotherapy following resection of stage III colon cancer reduces subsequent mortality by as much as 30%. However, the extent to which adjuvant therapy is used outside the clinical trial setting, particularly among the elderly, is unknown. Methods: A retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results/Medicare-linked database identified 6262 patients aged 65 years and older with resected stage III colon cancer. The primary outcome was chemotherapy use within 3 months of surgery, as ascertained from Medicare claims. We examined the extent to which age at diagnosis was associated with adjuvant chemotherapy usage, and we adjusted for potential confounding based on differences in other patient characteristics with the use of multiple logistic regression. All P values were two-sided. Results: Age at diagnosis was the strongest determinant of chemotherapy: 78% of patients aged 65-69 years, 74% of those aged 70-74 years, 58% of those aged 75-79 years, 34% of those aged 80-84 years, and 11% of those aged 85-89 years received postoperative chemotherapy. The age trend remained pronounced after adjustment for potential confounding based on variation in patients' demographic and clinical characteristics and after exclusion of patients with any evident comorbidity (all P values <.001). Conclusions: Adjuvant chemotherapy for stage III colon cancer is used extensively, especially for patients under the age of 75 years. However, treatment rates decline dramatically with chronologic age. Because patients in their 70s and even 80s have a reasonable life expectancy, further efforts are needed to ensure that elderly patients have the opportunity to make informed decisions regarding this potentially curative treatment. |
| Keywords: | controlled study; treatment outcome; aged; aged, 80 and over; survival rate; retrospective studies; major clinical study; clinical feature; clinical trial; neutropenia; postoperative period; fluorouracil; diarrhea; patient selection; united states; cancer adjuvant therapy; cancer patient; chemotherapy, adjuvant; cancer staging; antineoplastic agent; cancer diagnosis; lymphatic metastasis; neoplasm staging; medical decision making; demography; controlled clinical trial; cohort studies; mucosa inflammation; randomized controlled trial; dehydration; colonic neoplasms; cohort analysis; age factors; data base; retrospective study; cancer mortality; time factors; age; health insurance; medicare; registries; folinic acid; colon cancer; comorbidity; colon resection; outcomes research; sepsis; bacteremia; cancer epidemiology; age distribution; informed consent; immunosurveillance; regression analysis; floxuridine; databases, factual; elderly care; drug use; income; continental population groups; levamisole; humans; human; male; female; united states centers for medicare and medicaid services; priority journal; article |
| Journal Title: | JNCI: Journal of the National Cancer Institute |
| Volume: | 93 |
| Issue: | 11 |
| ISSN: | 0027-8874 |
| Publisher: | Oxford University Press |
| Date Published: | 2001-06-06 |
| Start Page: | 850 |
| End Page: | 857 |
| Language: | English |
| PUBMED: | 11390534 |
| PROVIDER: | scopus |
| DOI: | 10.1093/jnci/93.11.850 |
| DOI/URL: | |
| Notes: | Export Date: 21 May 2015 -- Source: Scopus |
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