Adjuvant chemotherapy has been a guideline-recommended treatment for resected stage III colon cancer patients for over two decades. Although several chemotherapy regimens have demonstrated their safety and efficacy of use in elderly colorectal cancer patients, the utilization of adjuvant chemotherapy still occurs less frequent in elderly patients, particularly when comorbidities are present. Dr. Mei-chin Hsieh, lead author from Louisiana State University Health Sciences Center (LSUHSC) School of Public Health in New Orleans and her research colleagues at LSU and Louisiana Tumor Registry examined the association between comorbid conditions and receiving adjuvant chemotherapy in stage III colon cancer patients.
[Photo: Dr. Mei-chin Hsieh]
Stage III colon cancer patients who underwent surgical resection were obtained from ten CDC-NPCR population-based Specialized Registries which participated in the Comparative Effectiveness Research (CER) project. In this study, 7 out of 10 stage III colon cancer patients had at least one recorded comorbid condition. Of those patients (n=2,224) with comorbid condition(s), 43.5 percent had at least one Charlson comorbidity which was more pronounced in age ≥ 70. Patients with moderate to severe Charlson comorbidity and those with two or more Charlson comorbidities were less likely to receive adjuvant chemotherapy (OR=0.62 and OR=0.69 respectively) compared to those with non-Charlson comorbidity, after adjusting for age and other predictors. In addition, physicians tended to treat them with capecitabine or oxaliplatin which has a favorable safety profile compared with intravenous 5-fluorouracil/leucovorin.
Hsieh noted that comorbidities may limit treatment options due to the increasing toxicity of specific chemotherapy agents and reduction of life-expectancy. As the number or severity of comorbidities increased, the likelihood of receiving guideline-concordant chemotherapy treatment decreased comparatively in stage III colon cancer patients, particularly among the elderly. “Given that increasing age is paralleled by an increase in comorbid conditions” quoted Dr. Hsieh, “an enhanced personalized practice that takes into account the cancer patient’s coexisting chronic illnesses should be the focus for improving the quality of cancer care.” Other LSU investigators included Dr. Xiao-Cheng Wu, Ms. Mary O’Flarity, and Dr. Vivien W. Chen. The study was published in Cancer Medicine.