Chemotherapy may be overused among young and middle-aged patients with colon cancer, according to a study published in JAMA Surgery (published online January 25, 2017; doi: 10.1001/jamasurg.2016.5050).
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Postoperative systemic chemotherapy is often suggested as a treatment option for early-onset colon cancer. However, optimal treatment options for young and middle-aged adults with colon cancer and the effects on prognosis are unclear.
Janna Manjelievskaia, MPH, John P Murtha Cancer Center, Walter Reed National Military Medical Center (Bethesda, MD), and colleagues investigated the likelihood of young and middle-aged patients with colon cancer receiving postoperative systemic chemotherapy, as well as multi-agent chemotherapy, and resulting survival outcomes. Researchers analyzed data from 3143 patients aged 18 to 75 years with colon adenocarcinoma diagnosed between 1998 and 2007 included in the US Department of Defense’s Central Cancer Registry and Military Health System medical claims database. Patients were separated by age groups to compare likelihood of receiving chemotherapy and resulting survival outcomes among young (18-49 years), middle-aged (50-64 years), and older (65-75 years) individuals.
Results of the study showed that young and middle-aged patients had a 2- to 8-fold higher likelihood of receiving postoperative systemic chemotherapy compared with older patients across all tumor stages. Middle-aged patients with stage I and stage II colon adenocarcinoma were 5 times (odds ratio [OR], 5.04; 95% CI, 2.30-11.05) and 2 times (OR, 2.42; 95% CI, 1.58-3.72) more likely to receive postoperative chemotherapy compared with older adults, respectively. Additionally, both young (OR, 2.48; 95% CI, 1,42-4,32) and middle-aged (OR, 2.66 95% CI, 1.70-4.18) patients were 2 times more likely to receive multi-agent chemotherapy compared with older patients.
Among patients who received surgery and postoperative systemic chemotherapy, no significant differences were observed in survival outcomes among age groups.
Researchers concluded that additional use of postoperative systemic chemotherapy among young and middle-aged persons without matched survival improvement indicates a general overuse of chemotherapy among patients in these age groups with colon cancer. Further research is needed to validate this claim.
