Use of adjuvant chemotherapy and radiation therapy for rectal cancer among the elderly: A population-based study

Alfred I. Neugut, Aaron T. Fleischauer, Vijaya Sundararajan, Nandita Mitra, Daniel F. Heitjan, Judith S. Jacobson, Victor R. Grann

Research output: Contribution to journalArticle

135 Citations (Scopus)

Abstract

Purpose: Combined adjuvant fluorouracil (5-FU)-based chemotherapy with radiation is now the standard of care for locally advanced rectal cancer in the United States. We investigated the use of these treatments for stages II and III rectal cancer among the elderly and the effectiveness of these treatments on a population-based scale. Patients and Methods: The linked Surveillance, Epidemiology, and End-Results-Medicare database was used to identify 1,807 Medicare beneficiaries ≥ 65 years of age with stage II or III rectal cancer who underwent surgical resection between 1992 and 1996. We excluded members of a health maintenance organization in the 12 months before or 4 months after their diagnosis and those who died within 4 months of diagnosis. We used multivariate analysis to identify factors associated with combined 5-FU and radiation therapy, and propensity score methodology to determine survival benefit for those treated. Results: We found that 37% of patients received both adjuvant 5-FU and radiation therapy, 11% 5-FU alone, and 14% radiation alone. Decreasing age, increasing lymph node positivity, comorbid conditions, and nonblack race were associated with increased probability of treatment with 5-FU and radiation. Combined chemotherapy/radiation therapy was associated with improved survival for stage III (relative risk, 0.71; 95% confidence interval, 0.56 to 0.90), but not for stage II rectal cancer (relative risk, 0.89; 95% confidence interval, 0.70 to 1.14). Conclusion: The association of combined treatment with improved survival in node-positive disease was similar to that observed in other studies. In the absence of data from well-designed randomized controlled trials, our observational data support efforts on the part of clinicians to make appropriate referrals and provide combined treatment for elderly patients with stage III rectal cancer.

Original languageEnglish (US)
Pages (from-to)2643-2650
Number of pages8
JournalJournal of Clinical Oncology
Volume20
Issue number11
DOIs
StatePublished - Jun 1 2002

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Adjuvant Chemotherapy
Rectal Neoplasms
Fluorouracil
Radiotherapy
Population
Radiation
Medicare
Survival
Confidence Intervals
Drug Therapy
Propensity Score
Health Maintenance Organizations
Therapeutics
Standard of Care
Epidemiology
Referral and Consultation
Multivariate Analysis
Randomized Controlled Trials
Lymph Nodes
Databases

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Use of adjuvant chemotherapy and radiation therapy for rectal cancer among the elderly : A population-based study. / Neugut, Alfred I.; Fleischauer, Aaron T.; Sundararajan, Vijaya; Mitra, Nandita; Heitjan, Daniel F.; Jacobson, Judith S.; Grann, Victor R.

In: Journal of Clinical Oncology, Vol. 20, No. 11, 01.06.2002, p. 2643-2650.

Research output: Contribution to journalArticle

Neugut, Alfred I. ; Fleischauer, Aaron T. ; Sundararajan, Vijaya ; Mitra, Nandita ; Heitjan, Daniel F. ; Jacobson, Judith S. ; Grann, Victor R. / Use of adjuvant chemotherapy and radiation therapy for rectal cancer among the elderly : A population-based study. In: Journal of Clinical Oncology. 2002 ; Vol. 20, No. 11. pp. 2643-2650.
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abstract = "Purpose: Combined adjuvant fluorouracil (5-FU)-based chemotherapy with radiation is now the standard of care for locally advanced rectal cancer in the United States. We investigated the use of these treatments for stages II and III rectal cancer among the elderly and the effectiveness of these treatments on a population-based scale. Patients and Methods: The linked Surveillance, Epidemiology, and End-Results-Medicare database was used to identify 1,807 Medicare beneficiaries ≥ 65 years of age with stage II or III rectal cancer who underwent surgical resection between 1992 and 1996. We excluded members of a health maintenance organization in the 12 months before or 4 months after their diagnosis and those who died within 4 months of diagnosis. We used multivariate analysis to identify factors associated with combined 5-FU and radiation therapy, and propensity score methodology to determine survival benefit for those treated. Results: We found that 37{\%} of patients received both adjuvant 5-FU and radiation therapy, 11{\%} 5-FU alone, and 14{\%} radiation alone. Decreasing age, increasing lymph node positivity, comorbid conditions, and nonblack race were associated with increased probability of treatment with 5-FU and radiation. Combined chemotherapy/radiation therapy was associated with improved survival for stage III (relative risk, 0.71; 95{\%} confidence interval, 0.56 to 0.90), but not for stage II rectal cancer (relative risk, 0.89; 95{\%} confidence interval, 0.70 to 1.14). Conclusion: The association of combined treatment with improved survival in node-positive disease was similar to that observed in other studies. In the absence of data from well-designed randomized controlled trials, our observational data support efforts on the part of clinicians to make appropriate referrals and provide combined treatment for elderly patients with stage III rectal cancer.",
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AU - Sundararajan, Vijaya

AU - Mitra, Nandita

AU - Heitjan, Daniel F.

AU - Jacobson, Judith S.

AU - Grann, Victor R.

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N2 - Purpose: Combined adjuvant fluorouracil (5-FU)-based chemotherapy with radiation is now the standard of care for locally advanced rectal cancer in the United States. We investigated the use of these treatments for stages II and III rectal cancer among the elderly and the effectiveness of these treatments on a population-based scale. Patients and Methods: The linked Surveillance, Epidemiology, and End-Results-Medicare database was used to identify 1,807 Medicare beneficiaries ≥ 65 years of age with stage II or III rectal cancer who underwent surgical resection between 1992 and 1996. We excluded members of a health maintenance organization in the 12 months before or 4 months after their diagnosis and those who died within 4 months of diagnosis. We used multivariate analysis to identify factors associated with combined 5-FU and radiation therapy, and propensity score methodology to determine survival benefit for those treated. Results: We found that 37% of patients received both adjuvant 5-FU and radiation therapy, 11% 5-FU alone, and 14% radiation alone. Decreasing age, increasing lymph node positivity, comorbid conditions, and nonblack race were associated with increased probability of treatment with 5-FU and radiation. Combined chemotherapy/radiation therapy was associated with improved survival for stage III (relative risk, 0.71; 95% confidence interval, 0.56 to 0.90), but not for stage II rectal cancer (relative risk, 0.89; 95% confidence interval, 0.70 to 1.14). Conclusion: The association of combined treatment with improved survival in node-positive disease was similar to that observed in other studies. In the absence of data from well-designed randomized controlled trials, our observational data support efforts on the part of clinicians to make appropriate referrals and provide combined treatment for elderly patients with stage III rectal cancer.

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