Who Gets Adjuvant Treatment for Stage II and III Rectal Cancer? Insight From Surveillance, Epidemiology, and End Results–Medicare

Schrag, Deborah; Gelfand, Sarah E.; Bach, Peter B.; Guillem, José G.; Minsky, Bruce D.; Begg, Colin B.

doi:10.1200/jco.2001.19.17.3712

Cited by 143 publications

(100 citation statements)

References 33 publications

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“…11 In a study of California Cancer Registry data including 1,956 patients, Ayanian et al 12 found that patients age 85 years or older were significantly less likely than younger patients to receive adjuvant radiotherapy for rectal cancers. Schrag et al 13 reported similar results in 1,670 patients with stage II and III rectal cancer identified through the Surveillance, Epidemiology, and End-Results-Medicare linked database. In this study, patients age 85 years or older were significantly less likely to receive radiotherapy or chemoradiotherapy, even after adjusting for degree of comorbidity.…”

Section: Discussionsupporting

confidence: 59%

Longitudinal Patterns of Chemotherapy Use in Metastatic Colorectal Cancer

Zafar

Marcello²,

Wheeler

et al. 2009

JOP

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Purpose: Patients with metastatic colorectal cancer (mCRC) are increasingly exposed to multiple chemotherapy regimens. Insight into patterns of care in mCRC is crucial to understanding physician and patient decision making. Methods: Patients with mCRC diagnosed between June2003 and June 2006 were identified from one academic and nine community oncology practices in the southeastern United States. Demographic, disease, treatment, and toxicity data were abstracted by retrospective medical record review. Results:After screening 738 medical records, 110 patients were determined eligible. Of these, mean age was 58 years (standard deviation, 12 years), 74% had stage IV disease at diagnosis, 39% were male, 53% were white, 26% were black, and 13% were age 70 years or older. As part of first-line mCRC chemotherapy, 100% of patients received regimens containing fluorouracil (FU), 87% received oxaliplatin (95% CI, 81% to 93%), 12% received irinotecan (95% CI, 6% to 18%), and 74% received bevacizumab (95% CI, 66% to 82%). The proportions of patients receiving subsequent lines of chemotherapy were: second line, 48% (n ϭ 53); third line, 26% (n ϭ 29); fourth line, 14% (n ϭ 15); and fifth line, 5% (n ϭ 5). From first-to third-line therapy, use of oxaliplatin and bevacizumab decreased, whereas irinotecan use increased. Among patients for whom therapy was discontinued, 29% experienced disease progression (PD), and 19% experienced toxicity; for 27%, no reason for discontinuation was documented. Of regimens containing oxaliplatin and irinotecan, 22% (n ϭ 25 of 114) and 34% (n ϭ 20 of 59) were discontinued because of PD, respectively. Of the same regimens, 19% (n ϭ 21 of 114) and 20% (n ϭ 12 of 59) were discontinued because of toxicity, respectively.Conclusion: FU, oxaliplatin, and bevacizumab were most commonly used in first-line therapy for mCRC, despite data showing equivalency between regimens containing oxaliplatin and irinotecan. Use of oxaliplatin decreased and irinotecan use increased as treatment progressed beyond first-line therapy.

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Section: Discussionsupporting

confidence: 59%

Longitudinal Patterns of Chemotherapy Use in Metastatic Colorectal Cancer

Zafar

Marcello²,

Wheeler

et al. 2009

JOP

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“…The need for aggressive social policy is only highlighted further here. Differences in receipt of treatment have been reported in many prior studies (38)(39)(40)(41)(42)(43)(44). A major finding of ours was that African-Americans received surgery less often than in the other groups.…”

Section: Discussionsupporting

confidence: 58%

Effects of Socioeconomic Status and Treatment Disparities in Colorectal Cancer Survival

Le¹,

Ziogas

Lipkin

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

182

145

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Background: Poor survival among colorectal cancer (CRC) cases has been associated with African-American race and low socioeconomic status (SES). However, it is not known whether the observed poor survival of African-American CRC cases is due to SES itself and/or treatment disparities. We set out to determine this using data from the large, population-based California Cancer Registry database. Methods: A case-only analysis of CRC was conducted including all age groups using California Cancer Registry data from 1994 to 2003, including descriptive analysis of relevant clinical variables, race, and SES. CRC-specific survival univariate analyses were conducted using the Kaplan-Meier method. Multivariate survival analyses were done using Cox proportional hazards ratios (HR). Results: Incident cases of colon (90,273) and rectal (37,532) cancer were analyzed, including 91,739 (71.8%) non-Hispanic Whites, 8,535 (6.7%) African-Americans,

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“…Prior research has shown that not only do treatment rates decline dramatically with increasing age [51], but older age is associated with delayed chemotherapy initiation [52] and lower rates of chemotherapy completion [53]. These age disparities in treatment patterns are associated with higher mortality [52,53] and In addition, the SEER-Medicare database does not provide data on performance status or lifestyle factors, such as smoking.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of chemotherapy in elderly patients with metastatic colorectal cancer.

Satram‐Hoang

Ramanan

Lee

et al. 2012

JCO

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Purpose Treatment advances have improved outcomes in clinical trials of patients with metastatic colorectal cancer (mCRC). Less is known about these effects for patients in real-world settings. This study evaluated treatment patterns and survival in older, demographically diverse patients with mCRC. Results Compared to 5-FU/LV, patients treated with CAP were older (mean age 78 vs. 76; P< 0.0001) and more likely female (61 vs. 54 %; P00.0017), while patients receiving CAPOX and FOLFOX were similar in age (mean age 74 vs. 73; P00.0924). Complications requiring medical resource utilization following initiation of therapy were significantly higher among patients administered with 5-FU/LV (54 %) vs. CAP (17 %; P < 0.0001) and FOLFOX (75 %) vs. CAPOX (57 %; P < 0.0001). The multivariate analysis revealed no significant differences in survival between 5-FU/LV and CAP and between FOLFOX and CAPOX. Conclusions Overall survival was comparable between CAP and 5-FU/LV and between CAPOX and FOLFOX with fewer complications requiring medical resource utilization associated with CAP and CAPOX, thus confirming clinical trial results.

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Who Gets Adjuvant Treatment for Stage II and III Rectal Cancer? Insight From Surveillance, Epidemiology, and End Results–Medicare

Abstract: 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.

Cited by 143 publications

References 33 publications

Longitudinal Patterns of Chemotherapy Use in Metastatic Colorectal Cancer

Longitudinal Patterns of Chemotherapy Use in Metastatic Colorectal Cancer

Effects of Socioeconomic Status and Treatment Disparities in Colorectal Cancer Survival

Comparative effectiveness of chemotherapy in elderly patients with metastatic colorectal cancer.

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