Abstract
Introduction
Trends in the use of modern chemotherapeutic regimens, primary tumor resection, and the timing of chemotherapy and resection in older patients with stage IV colorectal cancer have not been evaluated.
Methods
We used Cancer Registry- and Medicare-linked data (2000–2009) to describe time trends in resection of the primary tumor and receipt of chemotherapy in patients ≥66 presenting with stage IV colorectal cancer (N = 16,168).
Results
The mean age was 77.8 ± 7.3 years; 53.8 % were women and 82.9 % were white. Primary cancer sites were colon in 83.4 % and rectum in 16.6 %. Resection of the primary tumor decreased from 64.6 to 57.1 % (P < 0.0001) from 2001 to 2009. Systemic chemotherapy was given to 45.1 % of the patients. While the use of chemotherapy was stable over time (P = 0.48), the use of modern regimens containing oxaliplatin or irinotecan increased from 40.9 to 75.4 % (P < 0.0001). Bevacizumab use increased from 0.10 to 54.2 % (P < 0.0001). Survival improved by 4 % per year even after controlling for treatment and tumor location (HR = 0.96, 95 % CI 0.95–0.97).
Conclusions
Survival in older patients with stage IV disease is improving over time. Surgical resection is still performed in the majority of patients. Resection rates decreased while modern chemotherapy was rapidly adopted perhaps suggesting a shift in practice patterns.
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Acknowledgments
The collection of cancer incident data used in this study was supported by the Texas Department of State Health Services and Cancer Prevention Research Institute of Texas as part of the statewide cancer reporting program and the Centers for Disease Control and Prevention’s National Program of Cancer Registries Cooperative Agreement #5U58/DP000824-05. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the DSHS, CPRIT, or CDC.
The collection of the California cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and +Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries under agreement No. U55/CCR921930-02 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.
Funding
Cancer Prevention Research in Texas grant #RP101207-P03, Clinical and Translational Science Award #UL1TR000071, and NIH T-32 grant #5T32DK007639.
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Vargas, G.M., Sheffield, K.M., Parmar, A.D. et al. Trends in Treatment and Survival in Older Patients Presenting with Stage IV Colorectal Cancer. J Gastrointest Surg 18, 369–377 (2014). https://doi.org/10.1007/s11605-013-2406-z
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DOI: https://doi.org/10.1007/s11605-013-2406-z