Patients who are young and middle-aged colon cancer patients are almost two to eight times greater than elderly patients for receiving postoperative chemotherapy, but there appears to be no additional survival advantage for these patients, a new study in JAMA Surgery suggests by Uniformed Services University of the Health Sciences (USU) researchers.
Colorectal cancer is the nation’s third leading cause of cancer-related death. There were over 49,000 deaths in the year 2016, and over 134,000 new cases are to be anticipated in the current year. Incidence and mortality in adults aged 50 years or more have actually declined in the U.S. in recent times, but for patients aged between 20 to 49 years, the trend has not yet been seen. Treatment strategies have yet to be established for those with young-onset colon cancer and their impacts on prognosis remain uncertain.
USU Professor Dr. Kangmin Zhu, in the Department 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 coauthors from the National Cancer Institute, and the John P. Murtha Cancer Center at USU (Department of Surgery) and the Walter Reed National Military Medical Center, looked at whether age differences occurred in receiving chemotherapy and whether matched survival benefits existed with the receipt of postoperative chemotherapy in colon cancer patients. They compared data from the Department of Defense’s Central Cancer Registry and Military Health System medical claims files. The sample included 3,143 patients, aged 18 to 75, with histologically confirmed primary colon cancer who were diagnosed between 1998 and 2007.
59 percent of these patients were men. Young (18-49 years) and middle-aged patients (50-64 years) were two to eight times more likely to undergo postoperative systemic chemotherapy, as compared with older patients (65-75 years), irrespective of tumor stage at diagnosis. Young and middle-aged individuals were 2.5 times more likely to undergo multi-agent chemotherapy regimens. Also, although only surgery patients being young and middle-aged had better survival than patients who were elderly, no difference in survival occurred between young/middle-aged patients and elderly patients who received postoperative systemic chemotherapy in addition to surgery.
Most of the younger patients were treated with post-surgical systemic chemotherapy, such as multi-agent regimens, not now advisable for most early-stage colon cancer patients. Our results indicate that young and middle-aged adults with colon cancer might be over-treated,” Zhu said.