Adjuvant treatment for elderly patients with stage III colon cancer in the southern Netherlands is affected by socioeconomic status, gender, and comorbidity

Lemmens, Valery; Halteren, A. van; Janssen‐Heijnen, M.L.G.; Vreugdenhil, Gerard; Driel, O. Repelaer Van; Coebergh, Jan Willem

doi:10.1093/annonc/mdi159

Cited by 125 publications

(81 citation statements)

References 25 publications

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“…15,18,26 -29 The proportion of untreated patients was particularly high among patients with metastatic solid tumors 26 and was most notable among patients older than age 70 years 15,27 and older than age 75 years. 18,28,29 Although guidelines suggest that chemotherapy should be reserved for patients with a good PS, 47 of 108 chemotherapy-treated patients in the current study had a PS Ն2. Therefore, we analyzed factors that were associated with receiving chemotherapy in the evaluated population.…”

Section: Discussionmentioning

confidence: 68%

The influence of comorbidities, age, and performance status on the prognosis and treatment of patients with metastatic carcinomas of unknown primary site

Sève

Sawyer

Hanson

et al. 2006

Cancer

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BACKGROUNDThe authors investigated how comorbidities, age, and performance status were related to the choice of chemotherapy and to the prognosis of patients with carcinomas of unknown primary site (CUP).METHODSPatients in Northern Alberta who were diagnosed with CUP during 2000 to 2003 were included (n = 389 patients). Survival was compared by age at diagnosis (ages <65 years, 65‐74 years, and >75 years), comorbidity score (Adult Comorbidity Evaluation‐27 [ACE‐27] scores of 0‐1 and >2), performance status (PS), and other explanatory variables, such as gender, histology, and site and number of metastases.RESULTSThe median age was 68 years, and the median overall survival was 12 weeks. An ACE‐27 overall comorbidity score >2 was found in 34% of patients, and a PS >2 was observed in 50% of patients. Multivariate analysis showed that patients who had a PS ≥2 and a high overall ACE‐27 score had a worse prognosis. The impact of comorbidities on survival was limited to patients with low PS. Patients who were not evaluated at a cancer center were older, had a worse functional status, and had more moderate or severe comorbidities. Among the 257 patients who were evaluated at a cancer center, 108 patients received chemotherapy, and 121 patients had a good PS (0‐1). Age was the only independent variable that was related to the likelihood of not receiving chemotherapy among patients who had a good PS. The median overall survival of the 121 patients who had a good PS was 317 days, and overall survival was not associated significantly with chemotherapy. A logistic regression analysis that included all patients who were evaluated at a cancer center identified young age, good PS, lymph node/pleural involvement, and few comorbidities as variables that were associated independently with receiving chemotherapy.CONCLUSIONSPatients with CUP who were not evaluated at a cancer center were older, had a worse functional status, and had more moderate or severe comorbidities; this referral bias largely explained the differences between data from registries and from tertiary centers. Moderate and severe comorbidities impacted survival in patients with who had a PS ≥2. An age‐related decline was observed in the percentage of adults with good PS who received chemotherapy. The current results suggested that older patients with CUP were under treated and that factors other than PS were involved in the decision to use chemotherapy for the treatment of patients with CUP. Cancer 2006. © 2006 American Cancer Society.

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Section: Discussionmentioning

confidence: 68%

The influence of comorbidities, age, and performance status on the prognosis and treatment of patients with metastatic carcinomas of unknown primary site

Sève

Sawyer

Hanson

et al. 2006

Cancer

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“…3,14 Nevertheless, data from Europe suggest that in the year 2000, only 20% to 25% of elderly patients received adjuvant chemotherapy. 5,26,27 When studied, older patients have indicated that the primary determinant of their decision regarding chemotherapy was their physician's advice. 28 The physician's attitude may explain the low utilization of adjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant treatments do not alter the quality of life in elderly patients with colorectal cancer

Bouvier

Jooste

Bonnetain

et al. 2008

Cancer

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BACKGROUND. The current study was performed to longitudinally assess the impact of adjuvant treatments on the quality of life (QoL) of elderly colorectal cancer survivors. METHODS. The Burgundy Digestive Cancer Registry was used to select all patients aged ≥75 years who were diagnosed with colorectal cancer between 2003 and 2005. A total of 209 patients were asked to complete questionnaires during the first year after diagnosis: at the time of inclusion in the study (Q0), at 3 months after the initial diagnosis (Q3), at 6 months after the initial diagnosis (Q6), and at 12 months after the initial diagnosis (Q12) using the European Organization for Research and Treatment of Cancer (EORTC) QLQ‐C30. A total of 125 patients (60%) responded. Mixed model analyses of variance for repeated measurement were used to compare QoL scores according to therapeutic schemes. Interactions between time of follow‐up and treatment were tested. RESULTS. Patient sex, age, location of the tumor, and TNM stage of disease did not appear to differ significantly between respondents and nonrespondents. Global Health and Emotional Functioning improved for colon cancer survivors between Q0 and Q12, and were noted to improve between Q3 and Q12 for rectal cancer patients. According to French recommendations, patients who received chemotherapy for stage III colon cancer (P = .176) or radiotherapy for rectal cancer (P = .959) reported no significant changes in Global Health compared with those patients not receiving adjuvant therapies. Patients treated with chemotherapy reported better Physical Functioning than patients who did not received chemotherapy (P = .0113). CONCLUSIONS. To the authors' knowledge, the current study is the first to examine trends over time with regard to the influence of adjuvant treatments for colon and rectal cancers on QoL in a general aged population. Providing evidence that adjuvant chemotherapy for colon cancer has no negative impact on the QoL of elderly patients is of great significance in encouraging clinicians to treat this population. Cancer 2008. © 2008 American Cancer Society.

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“…[12] There are several explanations why elderly patients receive adjuvant chemotherapy less often than younger patients, such as the presence of comorbidities, unfavourable performance status or patient refusal. [38][39][40] Our study is hampered by the lack of information about comorbidities and performance status of the patient at time of diagnoses. Nevertheless marked differences in performance status of patients between hospitals in the Netherlands have not been reported.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Disparities in quality of care for colon cancer between hospitals in the Netherlands

Elferink

Wouters

Krijnen

et al. 2010

European Journal of Surgical Oncology (EJSO)

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Adjuvant treatment for elderly patients with stage III colon cancer in the southern Netherlands is affected by socioeconomic status, gender, and comorbidity

Cited by 125 publications

References 25 publications

The influence of comorbidities, age, and performance status on the prognosis and treatment of patients with metastatic carcinomas of unknown primary site

The influence of comorbidities, age, and performance status on the prognosis and treatment of patients with metastatic carcinomas of unknown primary site

Adjuvant treatments do not alter the quality of life in elderly patients with colorectal cancer

Disparities in quality of care for colon cancer between hospitals in the Netherlands

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