Medical Oncology

, Volume 28, Issue 4, pp 1062–1074

Assessing the initiation and completion of adjuvant chemotherapy in a large nationwide and population-based cohort of elderly patients with stage-III colon cancer

  • Chung-Yuan Hu
  • George L. Delclos
  • Wenyaw Chan
  • Xianglin L. Du
Original paper
  • 250 Downloads

Abstract

Randomized trials conducted in the 1980s have established the effectiveness of 5-fluorouracil-based adjuvant chemotherapy in treating stage-III colon cancer. However, the initiation of adjuvant chemotherapy is just the first step for survival improvement. Little is known about the actual completion rate of such a therapy in the community. The objectives of this study were to measure the initiation and completion rate of adjuvant chemotherapy and to identify the associated factors. We studied 12,265 patients aged 65+ diagnosed with stage-III colon cancer between 1991 and 2005 who were identified from the Surveillance, Epidemiology, and End Results-Medicare linked database. Chemotherapy initiation was defined as at least one claim indicating the use of chemotherapy. The first and last claims were used to measure the length of chemotherapy. A complete course of chemotherapy was defined as 8–13 months for 1991–1995 cohort and 5–7 months for 1996–2005 cohort according to clinical guideline. Of the 12,265 patients, 64.4% received adjuvant chemotherapy within 3 months after tumor resection. Among those who had chemotherapy initiated, 62.2% (or 38.0% of 12,265 patients) received a complete course of chemotherapy. Patient’s age at diagnosis, marital status, and comorbidity score were the significant predictors for chemotherapy initiation. These variables remained significant in predicting chemotherapy completion after adjusting for year of diagnosis and other factors. In conclusion, initiation and completion of chemotherapy was largely influenced by patient’s age, marital status and comorbidity. Further investigation is needed to explore the cause of these differences in adherence to standard treatment that is essential for better quality of cancer care.

Keywords

Colon cancer Chemotherapy Initiation Chemotherapy completion Elderly 

References

  1. 1.
    Horner MJ, Ries LAG, Krapcho M, et al. SEER cancer statistics review. Bethesda, MD, National Cancer Institute; 1975–2006.Google Scholar
  2. 2.
    Laurie JA, Moertel CG, Fleming TR, et al. Surgical adjuvant therapy of large-bowel carcinoma: an evaluation of levamisole and the combination of levamisole and fluorouracil. The North Central Cancer Treatment Group and the Mayo Clinic. J Clin Oncol. 1989;7:1447–56.PubMedGoogle Scholar
  3. 3.
    Erlichman C, Fine S, Wong A, et al. A randomized trial of fluorouracil and folinic acid in patients with metastatic colorectal carcinoma. J Clin Oncol. 1988;6:469–75.PubMedGoogle Scholar
  4. 4.
    Poon MA, O’Connell MJ, Moertel CG, et al. Biochemical modulation of fluorouracil: evidence of significant improvement of survival and quality of life in patients with advanced colorectal carcinoma. J Clin Oncol. 1989;7:1407–18.PubMedGoogle Scholar
  5. 5.
    The Nordic Gastrointestinal Tumor Adjuvant Therapy Group. Superiority of sequential methotrexate, fluorouracil, and leucovorin to fluorouracil alone in advanced symptomatic colorectal carcinoma: a randomized trial. J Clin Oncol. 1989;7:1437–46.Google Scholar
  6. 6.
    Moertel CG, Fleming TR, Macdonald JS, et al. Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med. 1990;322:352–8.PubMedCrossRefGoogle Scholar
  7. 7.
    NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. Jama. 1990; 264:1444–50.Google Scholar
  8. 8.
    Efficacy of adjuvant fluorouracil and folinic acid in colon cancer. International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) investigators. Lancet 1995; 345:939–44.Google Scholar
  9. 9.
    Engstrom PF, Benson AB 3rd, Cohen A, et al. NCCN colorectal cancer practice guidelines. The national comprehensive cancer network. Oncology (Williston Park). 1996;10:140–75.Google Scholar
  10. 10.
    Neugut AI, Matasar M, Wang X, et al. Duration of adjuvant chemotherapy for colon cancer and survival among the elderly. J Clin Oncol. 2006;24:2368–75.PubMedCrossRefGoogle Scholar
  11. 11.
    O’Connell MJ, Laurie JA, Kahn M, et al. Prospectively randomized trial of postoperative adjuvant chemotherapy in patients with high-risk colon cancer. J Clin Oncol. 1998;16:295–300.PubMedGoogle Scholar
  12. 12.
    Haller DG, Catalano PJ, Macdonald JS, et al. Phase III study of fluorouracil, leucovorin, and levamisole in high-risk stage II and III colon cancer: final report of Intergroup 0089. J Clin Oncol. 2005;23:8671–8.PubMedCrossRefGoogle Scholar
  13. 13.
    International Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) Investigators. Efficacy of adjuvant fluorouracil and folinic acid in B2 colon cancer. J Clin Oncol. 1999;17:1356–63.Google Scholar
  14. 14.
    Moertel CG, Fleming TR, Macdonald JS, et al. Intergroup study of fluorouracil plus levamisole as adjuvant therapy for stage II/Dukes’ B2 colon cancer. J Clin Oncol. 1995;13:2936–43.PubMedGoogle Scholar
  15. 15.
    Schrag D, Cramer LD, Bach PB, et al. Age and adjuvant chemotherapy use after surgery for stage III colon cancer. J Natl Cancer Inst. 2001;93:850–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Steele GD, Jessup JM. Colorectal cancer. In: Steele GD, Jessup JM, Winchester DP, et al., editors. National cancer data base: annual review of patients care 1995. Atlanta, GA: American Cancer Society; 1995.Google Scholar
  17. 17.
    Ragland KE, Selvin S, Merrill DW. Black-white differences in stage-specific cancer survival: analysis of seven selected sites. Am J Epidemiol. 1991;133:672–82.PubMedGoogle Scholar
  18. 18.
    Hodgson DC, Fuchs CS, Ayanian JZ. Impact of patient and provider characteristics on the treatment and outcomes of colorectal cancer. J Natl Cancer Inst. 2001;93:501–15.PubMedCrossRefGoogle Scholar
  19. 19.
    Du X, Goodwin JS. Patterns of use of chemotherapy for breast cancer in older women: findings from Medicare claims data. J Clin Oncol. 2001;19:1455–61.PubMedGoogle Scholar
  20. 20.
    Cooper GS, Yuan Z, Stange KC, et al. Agreement of Medicare claims and tumor registry data for assessment of cancer-related treatment. Med Care. 2000;38:411–21.PubMedCrossRefGoogle Scholar
  21. 21.
    Warren JL, Harlan LC, Fahey A, et al. Utility of the SEER-Medicare data to identify chemotherapy use. Med Care. 2002;40:IV-55–61.Google Scholar
  22. 22.
    Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) Limited-Use Data (1973–2006), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2009, based on the November 2007 submission.
  23. 23.
    Potosky AL, Riley GF, Lubitz JD, et al. Potential for cancer related health services research using a linked Medicare-tumor registry database. Med Care. 1993;31:732–48.PubMedCrossRefGoogle Scholar
  24. 24.
    Du XL, Fang S, Vernon SW, et al. Racial disparities and socioeconomic status in association with survival in a large population-based cohort of elderly patients with colon cancer. Cancer. 2007;110:660–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.PubMedCrossRefGoogle Scholar
  26. 26.
    Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol. 1993;46:1075–9. discussion 1081-90.PubMedCrossRefGoogle Scholar
  27. 27.
    SEER-Medicare: calculation of comorbidity weights, National Cancer Institute (Accessed 4 Dec 2009).Google Scholar
  28. 28.
    Potosky AL, Harlan LC, Kaplan RS, et al. Age, sex, and racial differences in the use of standard adjuvant therapy for colorectal cancer. J Clin Oncol. 2002;20:1192–202.PubMedCrossRefGoogle Scholar
  29. 29.
    Hamel MB, Teno JM, Goldman L, et al. Patient age and decisions to withhold life-sustaining treatments from seriously ill, hospitalized adults. SUPPORT investigators. Study to understand prognoses and preferences for outcomes and risks of treatment. Ann Intern Med. 1999;130:116–25.PubMedGoogle Scholar
  30. 30.
    Weeks JC. Preferences of older cancer patients: can you judge a book by its cover? J Natl Cancer Inst. 1994;86:1743–4.PubMedCrossRefGoogle Scholar
  31. 31.
    Muss HB, Cohen HJ, Lichtman SM. Clinical research in the older cancer patient. Hematol Oncol Clin North Am. 2000;14:283–91.PubMedCrossRefGoogle Scholar
  32. 32.
    Sudano JJ, Baker DW. Explaining US racial/ethnic disparities in health declines and mortality in late middle age: the roles of socioeconomic status, health behaviors, and health insurance. Soc Sci Med. 2006;62:909–22.PubMedCrossRefGoogle Scholar
  33. 33.
    Du XL, Meyer TE, Franzini L. Meta-analysis of racial disparities in survival in association with socioeconomic status among men and women with colon cancer. Cancer. 2007;109:2161–70.PubMedCrossRefGoogle Scholar
  34. 34.
    SEER-medicare data training (Nov 16–17, 2009). National Cancer Institute; 2009.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Chung-Yuan Hu
    • 1
  • George L. Delclos
    • 2
  • Wenyaw Chan
    • 3
  • Xianglin L. Du
    • 1
  1. 1.Division of Epidemiology, School of Public HealthThe University of Texas Health Science Center at HoustonHoustonUSA
  2. 2.Division of Environmental and Occupational Health Sciences, School of Public HealthThe University of Texas Health Science Center at HoustonHoustonUSA
  3. 3.Division of Biostatistics, School of Public HealthThe University of Texas Health Science Center at HoustonHoustonUSA

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