Reasons for Underuse of Adjuvant Chemotherapy in Elderly Patients With Stage III Colon Cancer

Ko, Jenny J.; Kennecke, Hagen F.; Lim, Howard John; Renouf, Daniel J.; Gill, Sharlene; Woods, Ryan; Speers, Caroline; Cheung, Winson Y.

doi:10.1016/j.clcc.2015.09.002

Cited by 44 publications

(39 citation statements)

References 22 publications

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“…These pooled results from randomized controlled trials are in line with most other retrospective reports, which found improved survival for adjuvant 5-FU/LV or capecitabine in stage III colorectal cancer, regardless of patient age [16,17,22,44,45] . Some retrospective data describe a reduced effect of 5-FU-based chemotherapy with rising patient age [18] .…”

Section: Evidence From Large Randomized Controlled Trialssupporting

confidence: 80%

“…Clearly, the rate of patients who are transferred to an oncologist postoperatively declines with rising patient age, as does the rate of patients who receive adjuvant chemotherapy after resection of stage III colorectal cancer [9,13,16,22] , despite data suggesting an oncological benefit for adjuvant treatment in elderly patients in general [9,13] . Seventy-eight percent of patients between 65 and 69 years of age receive systemic treatment.…”

Section: Application Rate Of Adjuvant Chemotherapy In Elderly Patientmentioning

confidence: 99%

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Effect of Adjuvant Chemotherapy on Elderly Colorectal Cancer Patients: Lack of Evidence

Nitsche¹,

Stöß²,

Friess³

2017

Gastrointest Tumors

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Background: Adjuvant chemotherapy has become the standard form of treatment for all patients with stage III colorectal cancer and is also recommended for patients with stage II disease and defined risk factors. However, clinical studies that evaluate the effect of adjuvant treatment regimens have a selection bias in favor of younger patients, so that even retrospective subgroup analyses cannot define the best therapeutic procedure in elderly patients with comorbidities. Summary: As long as the role of adjuvant chemotherapy in elderly colorectal cancer patients is not investigated in comprehensive trials, no clear recommendations are possible. Key Message: An exploratory review of the relevant literature revealed that a formal meta-analysis concerning adjuvant chemotherapy in elderly patients with colorectal cancer is not feasible due to varying definitions of elderly patients, inclusion and exclusion criteria, and a plethora of chemotherapeutic regimens. Practical Implications: Given the high incidence of colorectal cancer and the median age of 68 years for patients at the time of diagnosis, health economic considerations should promote randomized controlled trials regarding the role of adjuvant chemotherapy in the elderly.

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Section: Evidence From Large Randomized Controlled Trialssupporting

confidence: 80%

Section: Application Rate Of Adjuvant Chemotherapy In Elderly Patientmentioning

confidence: 99%

Effect of Adjuvant Chemotherapy on Elderly Colorectal Cancer Patients: Lack of Evidence

Nitsche¹,

Stöß²,

Friess³

2017

Gastrointest Tumors

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“…In the 1990s, the rate of AC was relatively small, ranging from 24% to 48% [19]. Recently, Ko and colleagues examined 810 CRC patients with lymph node metastases [20]. They found that 603 patients (74%) received AC postoperatively.…”

Section: Discussionmentioning

confidence: 99%

The C-Reactive Protein to Albumin Ratio as a Predictor of Severe Side Effects of Adjuvant Chemotherapy in Stage III Colorectal Cancer Patients

et al. 2016

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Background/AimsAdjuvant chemotherapy (AC) has been reported to improve the prognosis for patients with Stage III colorectal cancer (CRC). However, some patients experience severe side effects and must stop AC. The C-reactive protein (CRP) to albumin ratio (CAR) is a novel inflammation-based score that could reflect the patient’s general condition. The aim of this study was to evaluate the predictive value of the CAR for side effects of AC in CRC.MethodsA total of 136 CRC patients who received AC were retrospectively analyzed. The patients were subdivided into two groups by the CAR level (CAR ≥0.1, n = 30; CD < 0.1, n = 106).ResultsThe presence of lymphatic invasion, severe side effects, and discontinuation of AC were associated with high CAR levels (p = 0.02, <0.01, and 0.02; respectively). High levels of the Glasgow Prognostic Score (GPS) and the neutrophil to lymphocyte ratio (NLR) appeared to be associated with the CAR (p = 0.04, p<0.01; respectively). Multivariate analysis identified CAR≥0.1 (HR: 7.06, 95% CI: 2.51–19.88, p<0.01) as a significant determinant of severe side effects of AC. CAR had the highest area under the curve (0.79) among several inflammation-based scores.ConclusionThe present study showed that the CAR is a novel and promising inflammation-based score for ≥ grade 3 side effects of AC in node-positive CRC.

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“…Clinical trials often fail to enroll representative numbers of elderly patients, in part due to the difficulties of these patients meeting strict eligibility (3). Consequently, oncologists are often wary of treating elderly patients, and a number of studies have demonstrated lower rates of adjuvant therapy, and similar rates of chemotherapy toxicity (4,5). This suggests that well selected elderly patients can be effectively and safely treated similar to younger patients.…”

Section: Introductionmentioning

confidence: 99%

Utility of the Edmonton Frail Scale in identifying frail elderly patients during treatment of colorectal cancer

Meyers

Al-Shamsi

Rask

et al. 2017

J. Gastrointest. Oncol.

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Reasons for Underuse of Adjuvant Chemotherapy in Elderly Patients With Stage III Colon Cancer

Cited by 44 publications

References 22 publications

Effect of Adjuvant Chemotherapy on Elderly Colorectal Cancer Patients: Lack of Evidence

Effect of Adjuvant Chemotherapy on Elderly Colorectal Cancer Patients: Lack of Evidence

The C-Reactive Protein to Albumin Ratio as a Predictor of Severe Side Effects of Adjuvant Chemotherapy in Stage III Colorectal Cancer Patients

Utility of the Edmonton Frail Scale in identifying frail elderly patients during treatment of colorectal cancer

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