Effect of Age on Survival Benefit of Adjuvant Chemotherapy in Elderly Patients with Stage III Colon Cancer

Zuckerman, Ilene H.; Rapp, Thomas; Onukwugha, E.; Davidoff, Amy J.; Choti, Michael A.; Gardner, James M.; Seal, Brian; Mullins, C. Daniel

doi:10.1111/j.1532-5415.2009.02355.x

Cited by 60 publications

(50 citation statements)

References 28 publications

(66 reference statements)

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“…Clinical trials and observational studies have indicated that older patients and those with comorbidities benefit from adjuvant chemotherapy. [16][17][18][19] Gross et al observed that, based on 5-year survival, the benefit of adjuvant chemotherapy does not change regardless of the number of chronic health conditions in an individual patient. 20 Another study that surveyed a nationally representative sample of 1000 general surgeons and 1000 oncologists in the United States, however, indicated that both types of physicians hesitate to recommend adjuvant chemotherapy to patients aged >72 years or with comorbidities who have stage III colon cancer.…”

Section: Discussionmentioning

confidence: 99%

Association between receipt and timing of adjuvant chemotherapy and survival for patients with stage III colon cancer in Alberta, Canada

Lima

Yasui

Scarfe

et al. 2011

Cancer

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BACKGROUND: Surgery followed by adjuvant chemotherapy has been standard treatment for stage III colon cancer since 1990. However, to date, clinical trials have not been conducted to determine the definitive outer time limit by which adjuvant chemotherapy should be received for optimal survival benefit. The objective of the current study was to assess the association between the receipt/timing of adjuvant chemotherapy and patient survival in clinical practice. METHODS: Residents of Alberta who were diagnosed with stage III colon adenocarcinoma in years 2000 to 2005 who underwent surgery were included in the study. Patients were identified from the Alberta Cancer Registry and were linked to hospital data and neighborhood-level socioeconomic data from the 2001 Canadian Census. Cox proportional hazards models were used to estimate hazard ratios of death according to the timing of chemotherapy. RESULTS: There were 1053 patients in the study; 648 (61%) initiated adjuvant chemotherapy within 16 weeks of surgery. There was no difference in overall survival or colon cancer-specific survival between those who received adjuvant chemotherapy from 8 to 12 weeks postsurgery compared with those who received it within 8 weeks. However, those who received chemotherapy 12 to 16 weeks after surgery and those who either received it >16 weeks after surgery or received no treatment had a 43% and 107% greater risk of dying, respectively, than those who received chemotherapy within 8 weeks of surgery (hazard ratio, 1.43 [95% confidence interval, 0.96-2.13] and hazard ratio, 2.07 [95% confidence interval, 1.56-2.76], respectively). Analyses were controlled for age, year, and region of residence at diagnosis; sex; neighborhood-level socioeconomic factors; and number of comorbidities. CONCLUSIONS: The results from this study were consistent with current guideline recommendations in Alberta that patients with stage III adenocarcinoma should receive chemotherapy within 12 weeks of surgery. Cancer 2011;117:3833-

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Section: Discussionmentioning

confidence: 99%

Association between receipt and timing of adjuvant chemotherapy and survival for patients with stage III colon cancer in Alberta, Canada

Lima

Yasui

Scarfe

et al. 2011

Cancer

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“…Factors strongly associated with not receiving adjuvant chemotherapy were: patient age 75 years or older; diagnosed with stage II disease; presence of one or more serious co-morbidities; living in neighborhoods with low socio-economic indicators; and region of residence. Both clinical trials and population-based studies have shown that elderly patients and those with co-morbidities can benefit from pre-operative [6,9,10] and post-operative [8,[22][23][24][25][26] therapy. Older age and co-morbidities may be related to postsurgical complications or delayed recovery that could affect whether a patient received adjuvant chemotherapy and/or the timing of it; we were not able to evaluate these possibilities in our study.…”

Section: Discussionmentioning

confidence: 99%

Timing of Adjuvant Chemotherapy and Survival in Patients with Stage II/III Rectal Cancer

Lima¹,

Yasui²,

Scarfe³

et al. 2012

JCT

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Background: Treatment guidelines in the 1990s established surgery followed by chemoradiotherapy as the standard treatment for stage II/III rectal cancer. Our aim was to investigate the association between the timing of adjuvant treatment and patient survival in practice and identify demographic/clinical factors associated with treatment patterns. Methods: All residents of Alberta diagnosed with stage II/III rectal adenocarcinoma in 2000-2005 who had surgery were included in the study. Demographic and clinical data were obtained from the Alberta Cancer Registry and linked to hospital data and socioeconomic data from the 2001 Canadian Census. Overall and cancer-specific hazard ratios of death were estimated using Cox proportional hazards models. Results: 1243 patients were included in the study; 636 (51%) patients received treatment consistent with guidelines. Patients who received adjuvant chemotherapy 12 -16 weeks after surgery or more than 16 weeks/ did not receive it had a 43% and 58% higher risk of rectal cancer death, respectively, compared to those who received it within 8 weeks of surgery. Conclusion: Adjuvant chemotherapy for stage II/III rectal cancer should be initiated within 12 weeks after surgery to maximize treatment benefits. Efforts to increase the proportion of patients treated within 12 weeks after surgery are needed.

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“…Some retrospective data describe a reduced effect of 5-FU-based chemotherapy with rising patient age [18] . However, the underlying cause of poorer outcome for elderly patients is not always well differentiated between the impact of chronological age and biological factors such as performance status or comorbidity [18] .…”

Section: Evidence From Large Randomized Controlled Trialsmentioning

confidence: 99%

“…However, most studies use 70 years [13,15,16] or 75 years [17,18] as the cutoff point. Many clinical trials have age as exclusion criteria, which renders patients older than 70 years underrepresented in studies [9] .…”

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confidence: 99%

Effect of Adjuvant Chemotherapy on Elderly Colorectal Cancer Patients: Lack of Evidence

Nitsche¹,

Stöß²,

Friess³

2017

Gastrointest Tumors

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Background: Adjuvant chemotherapy has become the standard form of treatment for all patients with stage III colorectal cancer and is also recommended for patients with stage II disease and defined risk factors. However, clinical studies that evaluate the effect of adjuvant treatment regimens have a selection bias in favor of younger patients, so that even retrospective subgroup analyses cannot define the best therapeutic procedure in elderly patients with comorbidities. Summary: As long as the role of adjuvant chemotherapy in elderly colorectal cancer patients is not investigated in comprehensive trials, no clear recommendations are possible. Key Message: An exploratory review of the relevant literature revealed that a formal meta-analysis concerning adjuvant chemotherapy in elderly patients with colorectal cancer is not feasible due to varying definitions of elderly patients, inclusion and exclusion criteria, and a plethora of chemotherapeutic regimens. Practical Implications: Given the high incidence of colorectal cancer and the median age of 68 years for patients at the time of diagnosis, health economic considerations should promote randomized controlled trials regarding the role of adjuvant chemotherapy in the elderly.

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Effect of Age on Survival Benefit of Adjuvant Chemotherapy in Elderly Patients with Stage III Colon Cancer

Abstract: These findings have important clinical and policy implications for the risk-benefit calculation induced by treatment in older patients with Stage III colon cancer. The results suggest that there is a benefit from chemotherapy, but the benefit is lower with older age.

Cited by 60 publications

References 28 publications

Association between receipt and timing of adjuvant chemotherapy and survival for patients with stage III colon cancer in Alberta, Canada

Association between receipt and timing of adjuvant chemotherapy and survival for patients with stage III colon cancer in Alberta, Canada

Timing of Adjuvant Chemotherapy and Survival in Patients with Stage II/III Rectal Cancer

Effect of Adjuvant Chemotherapy on Elderly Colorectal Cancer Patients: Lack of Evidence

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