Overtreatment of Young Adults With Colon Cancer

Kneuertz, Peter J.; Chang, George J.; Hu, Chung Yuan; Rodrı́guez-Bigas, Miguel A.; Eng, Cathy; Vilar, Eduardo; Skibber, John M.; Feig, Barry W.; Cormier, Janice N.; You, Yong

doi:10.1001/jamasurg.2014.3572

Cited by 215 publications

(155 citation statements)

References 35 publications

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“…Second, our finding that young NHB individuals diagnosed with stage II colon cancer have a 60% to 70% higher risk of death compared with NHWs is interesting in light of existing data demonstrating that adjuvant therapy in stage II cancers is of marginal benefit (associated with improvements in overall survival of 5% or less). 28 In a recent nationwide cohort study of 13,102 patients diagnosed with CRC between the ages of 18 and 49 years, Kneuertz et al 15 found that young patients were significantly more likely than older patients to receive multiagent systemic chemotherapy at all disease stages, suggesting a trend toward overtreatment of young patients. Because use of adjuvant chemotherapy in stage II CRC is often at the discretion of the treating oncologist, it is possible that differences in the treatment of stage II cancers may contribute to racial disparities in survival.…”

Section: Discussionmentioning

confidence: 99%

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Racial/Ethnic Disparities in Survival Among Patients With Young-Onset Colorectal Cancer

Holowatyj

Ruterbusch

Rozek

et al. 2016

JCO

123

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Purpose Racial disparities in colorectal cancer (CRC) persist, despite overall reductions in morbidity and mortality. In addition, incidence is rising among individuals younger than 50 years of age. We compared the survival of young-onset CRC among non-Hispanic black (NHB), non-Hispanic white (NHW), and Hispanic individuals. Patients and Methods Using the National Cancer Institute's Surveillance, Epidemiology, and End Results program data, we identified individuals between the ages of 20 and 49 years, diagnosed with CRC between 2000 and 2009. Survival rates and Cox proportional hazards models were used to compare stage-specific 5-year survival among NHBs, NHWs, and Hispanics. Results We identified 28,145 patients with young-onset CRC (19,497 NHW; 4,384 NHB; 4,264 Hispanic) during the 10-year study period. Overall survival at 5 years after CRC diagnosis was 54.9% among NHB, 68.1% among NHW, and 62.9% among Hispanic individuals (P <.001). NHB individuals had a significantly higher hazard of cancer-specific death compared with NHWs after adjusting for age, sex, race, stage, county-level poverty, and treatment history in cases of colon (hazard ratio [HR], 1.35; 95% CI 1.26 to 1.45) and rectum/rectosigmoid junction (HR, 1.51; 95% CI, 1.37 to 1.68) cancers, whereas there was no significant difference in survival between NHWs and Hispanics. The greatest racial disparities in cancer-specific survival were observed among NHB and NHW patients diagnosed with stage II cancers of the colon (HR, 1.69; 95% CI, 1.33 to 2.14) and stage III cancers of the rectum (HR, 1.98; 95% CI, 1.63 to 2.40). Conclusion Survival after CRC diagnosis at a young age is significantly worse among NHBs compared with NHWs, even among patients with early-stage disease. Further study is needed to determine whether differences in tumor biology and/or treatment are associated with racial disparities in outcomes, which would have implications for CRC treatment and prevention.

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Section: Discussionmentioning

confidence: 99%

“…12 Young patients are more likely than their older counterparts to present with regional or distant disease, and although some studies have suggested that CRCs behave more aggressively in young patients, 13,14 others have demonstrated improved disease-specific survival compared with individuals diagnosed at older ages. 15-17 …”

Section: Introductionmentioning

confidence: 99%

Racial/Ethnic Disparities in Survival Among Patients With Young-Onset Colorectal Cancer

Holowatyj

Ruterbusch

Rozek

et al. 2016

JCO

123

View full text Add to dashboard Cite

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“…While some studies showed poorer survival for young patients as compared to their older counterparts, 6, 7 others found better or comparable survival among younger patients. 8–13 …”

Section: Introductionmentioning

confidence: 99%

“…Since prognosis of colon cancer among young patients is not well known, it is difficult to advise about adjuvant chemotherapy, 13 and treatment options for patients with young-onset CRC remain unclear. 24 Thus, overuse of chemotherapy may be more likely for younger patients.…”

Section: Introductionmentioning

confidence: 99%

Chemotherapy Use and Survival Among Young and Middle-Aged Patients With Colon Cancer

et al. 2017

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Importance Treatment options for young-onset colon cancer patients remain to be defined and their effects on prognosis are unclear. Objective To investigate receipt of adjuvant chemotherapy by age category (18-49, 50-64, and 65-75) and assess if age differences in chemotherapy matched survival gains among patients diagnosed with colon cancer in an equal access healthcare system. Design A cohort study was conducted based on cancer registry and administrative medical claims data. Setting This study was based on linked and consolidated data from the U.S. Department of Defense’s Central Cancer Registry and Military Heath System medical claims databases. Participants Participants were 3,143 patients ages 18 to 75 with histologically confirmed primary colon adenocarcinoma diagnosed between 1998 and 2007. Exposures Patients who underwent surgery and postoperative systemic chemotherapy. Main Outcomes and Measures The primary outcome measure of the study was overall survival of patients who only received surgery and those who received both surgery and post-operative systemic chemotherapy. Results Young and middle aged patients were two to eight times more likely to receive postoperative systemic chemotherapy as compared to older patients, across all tumor stages. Middle-aged patients with stage I (OR 5.04, 95% CI 2.30-11.05) and II (OR 2.42, 95% CI 1.58-3.72) disease were more likely to receive postoperative chemotherapy as compared to older patients. Both groups were two and a half times more likely to receive multi-agent chemotherapy than older patients. Among patients who received surgery and post-operative systemic chemotherapy, no significant differences were observed in survival between age groups. Conclusions and Relevance In an equal access healthcare system, we found potential overuse of chemotherapy among young and middle-aged adults with colon cancer. The addition of postoperative systemic chemotherapy did not result in matched survival improvement.

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“…Treating all Stage II patients is “overtreatment” 3 , as a small subset derives any therapeutic benefit, whereas others experience harm, a poorer quality of life, and no net benefit 4 . Prior attempts at identifying the subset of high-risk Stage II colon cancer patients have not been robust 5 , underscoring the need to discover prognostic and predictive biomarkers that can facilitate the selection of patients for additional treatment.…”

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confidence: 99%