Reasons for and outcomes of adjuvant chemotherapy choices in elderly patients with resected stage III colon cancer.

571 Background: Research suggests that elderly cancer patients are commonly undertreated, but the precise reasons for this are unclear. Robust clinical data on the optimal adjuvant chemotherapy regimen for elderly colon cancer patients are also lacking. Our aims were to: 1) evaluate the impact of advanced age on choice of adjuvant chemotherapy (none vs. capecitabine vs. FOLFOX) for curatively resected colon cancer; b) determine the reasons for selecting a particular regimen; and 3) examine whether treatment effect on outcomes is modified by age. Methods: All patients diagnosed with stage III colon cancer between 2006 and 2008, and referred to any 1 of 5 regional cancer centers in British Columbia, Canada were identified. Descriptive statistics were used to summarize treatment patterns among young patients (YPs) aged <70 years vs. elderly patients (EPs) aged >/=70 years. Multivariate logistic regression models were constructed to evaluate the association between adjuvant chemotherapy and cancer-specific survival (CSS) in YPs and EPs. Results: In total, 810 patients were identified: 51% were male, 52% YPs and 48% EPs, and 74% received adjuvant chemotherapy. When compared to YPs, EPs had worse ECOG and more comorbidities (both p<0.001). EPs were less likely than YPs to receive adjuvant chemotherapy (57% vs. 91%, p<0.001). Frequent reasons for no treatment included age, comorbidities, and small perceived benefit from adjuvant therapy. Among treated pts, EPs were less likely to receive FOLFOX (32% vs. 74%, p<0.0001) in favor of capecitabine due to patient preference, age, and comorbidities. In multivariate analyses, receipt of either FOLFOX or capecitabine was correlated with improved CSS compared to surgery alone. The effect of adjuvant chemotherapy on CSS was not modified by age (interaction p for capecitabine and age = 0.26; interaction p for FOLFOX and age = 0.40). Conclusions: EPs with stage III colon cancer frequently received either no adjuvant treatment or capecitabine monotherapy due to advanced age and co-morbidities. The treatment effect of adjuvant therapy on CSS is similar among EPs and YPs. Adjuvant chemotherapy should not be withheld from colon cancer patients based on advanced age alone.

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Surgeon and hospital variation in adjuvant chemotherapy delivery to patients with stage III colon cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.3596 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 3596-3596

Author(s):

Zhaomin Xu ◽

Carla Francesca Justiniano ◽

Adan Z Becerra ◽

Christopher Thomas Aquina ◽

Francis P. Boscoe ◽

...

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Cancer Patients ◽

New York State ◽

High Volume ◽

Stage Iii ◽

Stage Iii Colon Cancer ◽

Hospital Variation ◽

Comorbidity Burden

3596 Background: It is well established that age and comorbidities have significant impact on adjuvant chemotherapy delivery to stage III colon cancer patients. This study examines differences in the hospital and surgeon-specific probabilities of adjuvant therapy delivery to stage III colon cancer patients by comorbidity burden and age. Methods: Patients who underwent surgery for stage III colon cancer from 2004-2013 were included from the New York State Cancer Registry and the Statewide Planning and Research Cooperative System. Comorbidity burden was defined with the Charlson Comorbidity Index (CCI). Multilevel logistic regressions characterized variation in adjuvant chemotherapy delivery among individual hospitals and surgeons by CCI and age. Results: 11575 patients met inclusion criteria, of which 59% received adjuvant therapy. Younger age, lower CCI, and high volume surgeons/hospitals were associated with delivery of adjuvant therapy (p < 0.01). Median time to chemotherapy was 43 days among CCI = 0 vs 48 among CCI≥2. The risk adjusted hospital and surgeon-specific probabilities of adjuvant delivery decreased with increasing CCI and age. The proportion of variation attributable to surgeons, vs hospitals, increased with CCI and age. Hospital variation between the highest and lowest hospitals increased from a 6-fold difference among CCI = 0 to an 11 fold difference among CCI≥2. Surgeon variation increased from a 14-fold difference among CCI = 0 to a 40 fold difference among CCI≥2. Conclusions: Variation in adjuvant chemotherapy delivery to stage III colon cancer patients increased with higher comorbidity burden and age. While a larger proportion of variation is attributable to surgeons among patients with the highest CCI and the most elderly, the vast majority of the variation is related to hospital factors. Even taking into account that some patients may be unfit for adjuvant therapy, this variation in treatment is alarmingly high. [Table: see text]

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The effect of adjuvant chemotherapy for stage III colon cancer in elderly patients.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.611 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 611-611 ◽

Cited By ~ 1

Author(s):

Naomi Hayashi

Keyword(s):

Colon Cancer ◽

Multivariate Analysis ◽

Adjuvant Chemotherapy ◽

Elderly Patients ◽

Cancer Patients ◽

Recurrence Rate ◽

Significant Risk ◽

Stage Iii ◽

Risk Of Recurrence ◽

Stage Iii Colon Cancer

611 Background: Adjuvant chemotherapy (ACT) has been recommended for stage III colon cancer patients in NCCN guidelines. However, the benefit of ACT is still controversial in elderly patients. Methods: We retrospectively included stage III colon cancer patients with aged over 70 that were operated between 2008 and 2015 in Tosei general hospital from Japan. We calculated 3 years recurrence rate and performed a multivariate analysis to estimate the risk of recurrence. The model was adjusted by including the following 7 confounders: Age, ECOG-PS (0-1 or ≥ 2), tumor site (right or left), T stage (T1-3 or T4 ), N stage (N1 or N2), pathological type (por-sig or other), and complete ACT (yes or no). No complete ACT was defined as discontinuation ACT and surgery alone. Results: 182 patients were identified (87 patients aged < 70 and 95 patients aged ≥ 70). ACT was performed in 58 patients (61.1%) and complete rate was 67.2% in elderly patients. The median follow up was 36.0 months. 29 patients (30.0%) had relapse. 3 years recurrence rate was 24.3% and 37.8% with complete ACT or no complete ACT (p = 0.29). In multivariate analysis, N2 was only the risk of recurrence (HR 6.95, p < 0.01). In further analysis, addition of oxaliplatin was significant risk factor of recurrence in elderly patients (HR 10.4, p < 0.01). On the other hand, in young patients, no complete ACT was only risk of recurrence (p = 0.01). 3 years survival rate was 89.1% and 81.0% with complete ACT or no complete ACT (p = 0.27). Conclusions: The multivariate analysis showed that ACT did not reduce the risk of recurrence in elderly patients. Moreover, addition of oxaliplatin suggested not only futile but harmful in those patients. These results support the previous reports (MOSAIC study and PETACC-8 trial) that microsatellite instability and RAS status may affect the effect of oxaliplatin.

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Intensity of adjuvant chemotherapy regimens and grade III–V toxicities among elderly stage III colon cancer patients

European Journal of Cancer ◽

10.1016/j.ejca.2016.03.074 ◽

2016 ◽

Vol 61 ◽

pp. 1-10 ◽

Cited By ~ 7

Author(s):

F.N. van Erning ◽

L.G.E.M. Razenberg ◽

V.E.P.P. Lemmens ◽

G.J. Creemers ◽

J.F.M. Pruijt ◽

...

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Stage Iii ◽

Stage Iii Colon Cancer ◽

Grade Iii

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Trends in Disparities in Receipt of Adjuvant Therapy for Elderly Stage III Colon Cancer Patients

Medical Care ◽

10.1097/mlr.0b013e3181b58a85 ◽

2009 ◽

Vol 47 (12) ◽

pp. 1229-1236 ◽

Cited By ~ 25

Author(s):

Amy J. Davidoff ◽

Thomas Rapp ◽

Ebere Onukwugha ◽

Ilene H. Zuckerman ◽

Nader Hanna ◽

...

Keyword(s):

Colon Cancer ◽

Adjuvant Therapy ◽

Cancer Patients ◽

Stage Iii ◽

Stage Iii Colon Cancer

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Adjuvant Chemotherapy (AC) Initiation and Early Discontinuation in Elderly Patients (EPS) with Stage III Colon Cancer (CC)

Annals of Oncology ◽

10.1016/s0923-7534(20)33215-4 ◽

2012 ◽

Vol 23 ◽

pp. ix204-ix205

Author(s):

W. Cheung ◽

D. Renouf ◽

H. Lim ◽

H. Kennecke

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Elderly Patients ◽

Stage Iii ◽

Early Discontinuation ◽

Stage Iii Colon Cancer

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Abstract B56: Racial disparities in the receipt of adjuvant chemotherapy among stage III colon cancer patients

10.1158/1538-7755.disp14-b56 ◽

2015 ◽

Author(s):

Caitlin C. Murphy ◽

Linda C. Harlan ◽

Joan L. Warren ◽

Ann M. Geiger

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Racial Disparities ◽

Cancer Patients ◽

Stage Iii ◽

Stage Iii Colon Cancer

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Effect of postoperative complications on adjuvant chemotherapy use in stage III colon cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.3608 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 3608-3608

Author(s):

Ryan P Merkow ◽

David J Bentrem ◽

Mary Frances Mulcahy ◽

Clifford Y. Ko ◽

Karl Y. Bilimoria

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Postoperative Complications ◽

Adjuvant Therapy ◽

Anastomotic Leak ◽

The United States ◽

Stage Iii ◽

Treatment Gap ◽

Stage Iii Colon Cancer ◽

National Quality

3608 Background: The National Quality Forum has endorsed the use of adjuvant chemotherapy in stage III colon cancer, yet a substantial treatment gap exists in the United States. Our objective was to evaluate the contribution of postoperative complications on the use of adjuvant therapy after colectomy for cancer. Methods: Patients from the National Surgical Quality Improvement Program and the National Cancer Data Base who underwent colon resection for cancer were linked (2006-2008). The association of complications on adjuvant chemotherapy use was assessed using multivariable regression models. Results: From 140 hospitals, 2368 patients underwent resection for stage III colon adenocarcinoma. Overall, 36.8% (871/2,368) patients were not treated with adjuvant therapy, of which 47.8% (416/871) had documented severe comorbidities or advanced age (≥80) as the reason for no adjuvant therapy receipt. Of the remaining 455 patients, 21.3% (97/455) had ≥1 serious complication that could account for adjuvant therapy omission. The remaining 41.1% (358/871) patients did not have a documented reason for not recieving adjuvant therapy. Complications associated with adjuvant therapy omission were abscess/anastomotic leak (OR 1.91, 95% CI 1.02-3.59), renal failure (OR 7.16, 95% CI 1.92-26.79), prolonged ventilation (OR 7.92, 95% CI 2.97-21.13), re-intubation (OR 5.69, 95% CI 2.13-15.18), and pneumonia (OR 4.05, 95% CI 2.07-7.90). Abscess/anastomotic leak was associated with a 28-day delay in time to adjuvant chemotherapy (73 vs. 45 days, p<0.05). Superficial surgical site infection did not decrease adjuvant therapy receipt but delayed the time to its use (57 vs. 44 days, p<0.05). The occurrence of postoperative sepsis was associated with a 15-day delay to adjuvant chemotherapy (60 vs. 45 days, p<0.05). Conclusions: Serious postoperative complications explained nearly one quarter of the adjuvant chemotherapy treatment gap among stage III colon cancer patients. Postoperative complications affect treatment utilization and should be considered when calculating adherence with the Stage III adjuvant therapy for colon cancer measure. Judging provider performance using quality metrics is challenging without clinical data.

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Prognostic impact of preoperative albumin to globulin ratio in curative colon cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.647 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 647-647

Author(s):

Yuji Toiyama ◽

Hiroyuki Fujikawa ◽

Yasuhiro Inoue ◽

Hiroki Imaoka ◽

Masato Okigami ◽

...

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Poor Prognosis ◽

Early Recurrence ◽

Stage I ◽

Stage Iii ◽

Prognostic Impact ◽

Stage Iii Colon Cancer ◽

Albumin To Globulin Ratio

647 Background: Albumin to globulin ratio (AGR) has been reported to predict long term mortality in patients with several cancers. However, prognostic impact of preoperative AGR in colon cancer patients with curative intent has not yet been fully addressed. Therefore, we, for the first time, investigated the association between AGR and clinico-pathological findings including overall survival (OS) and disease free survival (DFS) in stage I-III colon cancer patients. Methods: Clinicopathological findings including preoperative laboratory data (carcinoembryonic antigen [CEA] and AGR) from 251 curative colon cancer patients were assessed as indicators of early recurrence and poor prognosis in this retrospective study. AGR was calculated as [AGR = albumin/ (total protein - albumin)]. The cut-off value of AGR was 1.32 in current study. Results: Several clinicopathological categories related with tumor progression such as lymph node metastasis, T4 tumor, large tumor size, undifferentiated tumor, venous and lymphatic invasion, and high CEA were significantly associated with low AGR level. The patients with low AGR were significantly poorer OS (P = 0.001) and DFS (P = 0.003) than those with high AGR, respectively. In addition, multivariate analyses demonstrated that low AGR was independently associated with early recurrence (HR = 2.87, P = 0.007) and poor prognosis (HR = 2.56, P = 0.008), respectively. On the other hand, sub analysis of survival curves revealed that stage III colon cancer patients with low AGR were significantly poorer OS (P = 0.007) and DFS (P = 0.02) than those with high AGR, respectively. Furthermore, significantly poorer OS and DFS were also shown in stage I-II colon cancer patients with low AGR, respectively (OS: P = 0.02, DFS: P = 0.01). Conclusions: Preoperative AGR was an independent predictor of early recurrence and poor prognosis in curative colon cancer patients. AGR may represent a simple, potentially useful predictive biomarker for selecting stage I-II colon cancer patients who might need adjuvant chemotherapy. Furthermore, AGR may select candidates who are better to introduce more intensive adjuvant chemotherapy after curative operation in stage III colon cancer patients.

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