Young and middle-aged patients with colon cancer are nearly two to eight times more likely to get postoperative chemotherapy than older patients, but there appears to be no additional survival benefits for those patients, a study published today in JAMA Surgery by researchers at the Uniformed Services University of the Health Sciences (USU) found.
Colorectal cancer is the third most common cause of cancer death in the U.S. There were over 49,000 deaths in 2016, and over 134,000 new cases are projected this year. Although incidence and mortality rates in adults aged 50 and older have declined in recent years in the U.S., the same pattern has not been seen for patients aged 20 to 49. Treatment modalities are yet to be established for young-onset colon cancer patients and their impact on prognosis is unknown.
Dr. Kangmin Zhu, USU professor of Preventive Medicine and Biostatistics, was lead author on the study, “Chemotherapy Use and Survival among Young and Middle-Aged Patients with genetic test for Colon Cancer.” He and his co-authors at the National Cancer Institute, and the John P. Murtha Cancer Center at USU (Department of Surgery) and the Walter Reed National Military Medical Center, investigated whether there were age differences in chemotherapy receipt and whether there were matched survival benefits with the administration of postoperative chemotherapy among patients with colon cancer. They used data from the Department of Defense’s Central Cancer Registry and Military Health System medical claims databases. There were 3,143 patients aged 18 to 75 with histologically confirmed primary colon cancer diagnosed between 1998 and 2007.
Of these patients, 59 percent of these patients were men. Young (18-49 years) and middle-aged (50-64 years) patients were twice to eight times as likely as older patients (65-75 years) to undergo postoperative systemic chemotherapy, regardless of stage of tumor at diagnosis. Young and middle-aged individuals were 2.5 times as likely as other individuals to undergo multi-agent chemotherapy regimens. Also, although only surgery recipients in young and middle-aged adults achieved superior survival in comparison with elderly patients, no significant difference was observed in survival between young/middle-aged patients and elderly patients receiving surgery plus postoperative systemic chemotherapy.
Most of the young patients received post-operative systemic chemotherapy, including multi-agent regimens, not currently recommended for most patients with early-stage colon cancer. Our findings suggest young and middle-aged adults with colon cancer may be over-treated,” Zhu said.
