Lifesaving treatment often not administered to elderly with colon cancer

NEW YORK, June 6, 2001 — The use of potentially curative chemotherapy following surgery for stage III colon cancer declines precipitously with patients’ advancing age. The likelihood of a patient being offered this treatment option, shown in previous studies to reduce the risk of cancer recurrence and mortality by 30 percent, declined as their age at diagnosis increased. The retrospective study of 6,262 Medicare patients aged 65 or older conducted by researchers at Memorial Sloan-Kettering Cancer Center was reported in the June 6 issue of the Journal of the National Cancer Institute.

“A quarter of patients aged 70 to 74 did not receive chemotherapy after resection and this number increased to 89 percent for patients aged 85 to 89," said Deborah Schrag, M.D., M.P.H, attending physician at Memorial Sloan-Kettering and the study’s first author. "It was clear that the chronologic age at diagnosis was highly associated with the receipt of post-operative therapy."

According to the study investigators, this finding suggests that there is persistent uncertainty among clinicians regarding whether or not the benefits outweigh the risks of treatment among the very old. It also illustrates the legacy of confusion that may arise when the elderly are not well represented in clinical trials.

The retrospective cohort study examined the SEER (Surveillance, Epidemiology and End Results) Medicare-linked database from 1991 through 1996 for claims from patients aged 65 years and older who had surgery within three months of diagnosis of stage III colon cancer (disease that has spread to the regional lymph nodes). Those identified were further evaluated for receipt of adjuvant chemotherapy following resection. The researchers found that chemotherapy was received by:

· 78 percent of patients aged 65 – 69 years
· 74 percent of patients aged 70 – 74 years
· 58 percent of patients aged 75 – 79 years
· 34 percent of patients aged 80 – 84 years
· 11 percent of patients aged 85 – 89 years.

Other clinical and demographic factors were evaluated in addition to age including sex, race, number of involved lymph nodes, socioeconomic status (identified by the median income of the patient’s census tract), year of diagnosis, and co-morbidity. Of these, age had the highest correlation to lack of treatment followed by co-morbidity. While it cannot be known if the elderly patients themselves chose not to receive adjuvant chemotherapy or did so based on their doctor’s recommendations, surveys of elderly patients have shown that their physicians’ advice is the primary determinant in their decision to receive curative chemotherapy. Study authors emphasize that further research is required to identify the reasons why treatment is often not administered.

"Because patients in their seventies and even in their eighties have a reasonable life expectancy, every effort must be made to ensure elderly patients have all of the necessary information to make informed decisions about potentially curative treatment," said Colin B. Begg, Ph.D., chairman of the Department of Epidemiology and Biostatistics at Memorial Sloan-Kettering and the study’s senior author.

Memorial Sloan-Kettering Cancer Center is the world’s oldest and largest private institution devoted to prevention, patient care, research and education in cancer. Throughout its long and distinguished history, the Center has played a leadership role in defining the standard of care for patients with cancer. Our teams of specialists and scientists have pioneered new approaches to understanding, diagnosing, and treating cancer and remain singularly focused on our mission: the progressive control and cure of cancer.