Management of stage <scp>III</scp> colon cancer in the elderly: Practice patterns and outcomes in the general population

Merchant, Shaila J.; Nanji, Sulaiman; Brennan, Kelly; Karim, Safiya; Patel, Sunil V.; Biagi, James; Booth, Christopher M.

doi:10.1002/cncr.30691

Cited by 25 publications

(27 citation statements)

References 28 publications

(50 reference statements)

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“…Overall, 75% of the study population received ACT. Although comparable with previous population based studies, the percentage patients receiving ACT was higher than the reported in recent studies [ 2 , 4 , 10 , 15 , 19 , 20 ]. This difference might be attributable to the high health insurance coverage in Puerto Rico (96.3%) [ 26 ] and the adherence of health professionals in Puerto Rico to evidence-based treatment guidelines recommended.…”

Section: Discussionsupporting

confidence: 90%

“…For patients with stage III colon cancer, the National Comprehensive Cancer Network (NCCN) guidelines recommends surgical resection and adjuvant chemotherapy (ACT) [ 1 ]. A robust body of evidence indicates that using ACT decreases the risk of recurrence and improves survival among stage III colon cancer patients [ 2 – 10 ]. It has also been demonstrated that including oxaliplatin in the drug combination has significantly improved the disease-free survival and overall survival, particularly in patients <70 years old [ 3 , 11 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, the benefit of oxaliplatin in patients age 70 and older has not been confirmed [ 1 , 3 , 8 , 9 ]. Nevertheless, even with the proven benefits of ACT, several studies have shown differences in the use of ACT by age, race/ethnicity, type of insurance coverage and socioeconomic status [ 2 , 10 , 11 , 15 – 21 ].…”

Section: Introductionmentioning

confidence: 99%

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Use of adjuvant chemotherapy in patients with stage III colon cancer in Puerto Rico: A population-based study

et al. 2018

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ObjectiveThis study aims to examine factors associated with the use of adjuvant chemotherapy and the use of oxaliplatin after curative resection in stage III colon cancer patients and assesses the effect of their use in three-year survival.MethodsThis retrospective cohort study was conducted using Puerto Rico Central Cancer Registry-Health Insurance Linkage Database. The study cohort consisted of stage III colon cancer patients with a curative surgery in the period 2008–2012. Multivariate logistic regression was used to estimate adjusted odds ratios. Kaplan-Meier methods and Cox proportional hazards models were used to assess the association between adjuvant chemotherapy and oxaliplatin use and overall survival and risk of death, respectively.ResultsOverall, 75% of the study population received adjuvant chemotherapy during the study period. Factors statistically associated with receiving adjuvant chemotherapy within four months after resection included being married (adjusted odds ratio [AOR] 1.64; 95% CI 1.18–2.28; p = 0.003), and being enrolled in Medicare (AOR 1.68; 95% CI: 1.03–2.75; p = 0.039) or Medicaid and Medicare dual eligible (AOR 1.66; 95% CI: 1.06–2.60; p = 0.028). However, patients aged ≥70 years were less likely to receive adjuvant chemotherapy (AOR 0.22; 95%CI 0.14–0.36; p<0.001).DiscussionWe observed a significant reduction in mortality in adjuvant chemotherapy treated patients. Similarly, patients <70 years treated with oxaliplatin had significantly lower risk of death than those who did not, although for patients ≥70 years no statistical significance was achieved. Future studies should assess effective interventions to reduce barriers to access guideline-based recommended colon cancer treatment.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Use of adjuvant chemotherapy in patients with stage III colon cancer in Puerto Rico: A population-based study

et al. 2018

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“…Among them, 41% received adjuvant chemotherapy in the 65-70 age group and only 33% in the >70 age group. This nding is similar to other cancers [26,27]. This may be due to two reasons.…”

Section: Discussionsupporting

confidence: 87%

Survival Analysis of Elderly Patients Over 65 Years Old With Stage Ii/iii Gastric Cancer Treated With Adjuvant Chemotherapy After Laparoscopic D2 Gastrectomy: a Retrospective Cohort Study

Liang

Zhao

Chen

et al. 2020

Preprint

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Background: The benefits of adjuvant chemotherapy for elderly patients (age >65) with gastric cancer (GC) remain unknown because elderly patients are underrepresented in most clinical trials. To evaluate the effectiveness and complications of adjuvant chemotherapy in elderly patients (>65 years of age) after laparoscopic D2 gastrectomy.Methods: This was a retrospective cohort study of elderly patients (>65 years) with stage II/III GC who underwent curative laparoscopic D2 gastrectomy between 2004 and 2018. The patients were divided as surgery alone and surgery plus adjuvant chemotherapy (chemo group). The overall survival (OS), disease-free survival (DFS), circulating tumor cells (CTCs), chemotherapy duration, and toxicity were examined. Results: There were 270 patients included: 169 and 101 in the surgery and chemo groups, respectively. There were ten (10/101) and six (6/101) patients with grade 3+ non-hematological and hematological adverse events. The 1-/3-/5-year OS rates of the surgery group were 72.9%/51.8%/48.3%, compared with 90.1%/66.4%/48.6% for the chemo group (log-rank test: P=0.018). For stage III patients, the 1-/3-/5-year OS rates of the surgery group were 83.7%/40.7%/28.7%, compared with 89.9%/61.2%/43.6% for the chemo group (log-rank test: P=0.015). Adjuvant chemotherapy was significantly associated with higher OS (HR=0.568, 95%CI: 0.357-0.903, P=0.017) and DFS (HR=0.511, 95%CI: 0.322-0.811, P=0.004) in stage III patients. CTC >0 had no significant impact on the benefits of adjuvant chemotherapy on OS and DFS.Conclusions: This study suggested that adjuvant chemotherapy significantly improves OS and DFS for elderly patients with stage III GC after D2 laparoscopic gastrectomy, with a tolerable adverse event profile.

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“…The screening program for CRC defined 65 years as a cutoff age (Papamichael et al 2009). In other previously published studies (McCleary et al 2013a;Merchant et al 2017;Tournigand et al 2012;Twelves et al 2005), 70 years was adopted as a cutoff age. Updated SEER-Medicare analysis data and three population-based data sets conducted by Sanoff et al (Sanoff et al 2012) showed that only 44% of the 5941 patients evaluated received adjuvant chemotherapy within 3 months of surgical resection for stage III CRC.…”

Section: Discussionmentioning

confidence: 99%

Peer Review #2 of "Impact of old age on resectable colorectal cancer outcomes (v0.1)"

Chavali¹

2019

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This study was performed to identify a reasonable cutoff age for defining older patients with colorectal cancer (CRC) and to examine whether old age was related with increased colorectal cancerspecific death (CSD) and poor colorectal cancer-specific survival (CSS). Methods: 76,858 eligible patients from the Surveillance, Epidemiology and End Results (SEER) database were included in this study. The Cox proportional hazards regression model and the Chow test were used to determine a suitable cutoff age for defining the older group. Furthermore, a propensity score matching analysis was performed to adjust for heterogeneity between groups. A competing risk regression model was used to explore the impact of age on CSD and non-colorectal cancer-specific death (non-CSD). Kaplan-Meier survival curves were plotted to compare CSS between groups. And a Cox regression model was used to validate the results. External validation was performed on data from 1998 to 2003 retrieved from the SEER database. Results: Based on a cutoff age of 70 years, the examined cohort of patients was classified into a younger group (n =51,915, <70 years of old) and an older group (n =24,943, ≥70 years of old). Compared with younger patients, older patients were more likely to have fewer lymph nodes sampled and were less likely to receive chemotherapy and radiotherapy. When adjusted for other covariates, agedependent differences of 5-year CSD and 5-year non-CSD were significant in the younger and older groups (15.84% and 22.42%, P < 0.001; 5.21% and 14.21%, P < 0.001). And an age of ≥70 years remained associated with worse CSS comparing with younger group (subdistribution hazard ratio [SHR], 1.51 [95% confidence interval [CI], 1.45-1.57], P < 0.001). The Cox regression model as a sensitivity analysis had a similar result. External validation also supported an age of 70 years as a suitable cutoff, and this older group was associated with having reduced CSS and increased CSD. Conclusions: Seventy is a suitable cutoff age to define those considered as having elderly CRC. Elderly CRC was associated with not only increased non-CSD but also with increased CSD. Further research is needed to provide evidence of whether cases of elderly CRC should receive stronger treatment if possible.

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Management of stage III colon cancer in the elderly: Practice patterns and outcomes in the general population

Abstract: Half of elderly patients with stage III colon cancer do not receive ACT. Although the effect size is smaller than that in younger patients, ACT is associated with improved long-term survival. Cancer 2017;123:2840-49. © 2017 American Cancer Society.

Cited by 25 publications

References 28 publications

Use of adjuvant chemotherapy in patients with stage III colon cancer in Puerto Rico: A population-based study

Use of adjuvant chemotherapy in patients with stage III colon cancer in Puerto Rico: A population-based study

Survival Analysis of Elderly Patients Over 65 Years Old With Stage Ii/iii Gastric Cancer Treated With Adjuvant Chemotherapy After Laparoscopic D2 Gastrectomy: a Retrospective Cohort Study

Peer Review #2 of "Impact of old age on resectable colorectal cancer outcomes (v0.1)"

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