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Women, Elders: Less Colon Cancer Chemo

More Patients Getting Chemotherapy for Advanced Colon Cancer, but Women and Elderly Lag
By
WebMD Health News
Reviewed by Louise Chang, MD

Dec. 6, 2005 -- Cancer experts report an increase in the numbers of patients with advanced colon cancer who get chemotherapy after cancer surgery.

But chemo use still lags among women and elderly patients, who are as likely to benefit from postsurgery chemo as other patients.

The finding comes from the National Cancer Institute's J. Milburn Jessup, MD, and colleagues. The report appears in The Journal of the American Medical Association.

Goal: More Chemo for Women, Elders

In a news release, Jessup commented on the findings.

"Our intent in part is to show that since women and elderly do benefit from adjuvant chemotherapy as much as men or younger patients do, then it will reassure both patients and doctors that it is a good thing to do," says Jessup, who also works at Georgetown University Medical Center.

Don't let the word "adjuvant" throw you. It just means "postsurgery."

"We really hope that this study will result in having both patients and physicians work together to use adjuvant therapy," he continues.

Decade of Data

Jessup's team checked the National Cancer Data Base for chemo use among patients with stage III colon cancer from 1990-2002. Stage III cancer includes the tumor with spread to nearby lymph nodes but not to distant areas.

Those years follow the 1990 publication of NIH guidelines on the topic. The guidelines recommend chemotherapy for all patients with stage III colon cancer who aren't enrolled in a clinical trial.

Jessup's team wanted to see if those guidelines prompted a rise in chemo use among people with stage III colon cancer.

More Patients Got Chemo

Chemo use by patients with advanced colon cancer increased after the guidelines were issued.

Consider these numbers from Jessup's study:

  • Chemo after surgery in 1990: 39% of patients with stage III colon cancer
  • Chemo after surgery in 2002: 64% of patients with stage III colon cancer

Survival also improved for patients who got chemotherapy after surgery for advanced colon cancer, the study shows.

Compared to patients who just get surgery, those who also get chemo are 16% more likely to survive for at least five years, the researchers write.

Chemo Use Lags in Women, Elders

Chemo use was slower to increase among blacks than whites. Their rates evened out in recent years, the study shows.

However, chemo use among women and elderly patients hasn't caught up. The reasons for those gaps aren't clear.

"Women have the same benefit but are less often treated," write Jessup and colleagues. "Elderly patients have the same benefit as younger patients but are also less often treated."

Jessup's team notes that the database didn't mention if patients had other illnesses or why chemotherapy wasn't used across the board.

Choosing or Declining Chemo

"It is not clear why it took so many years for a majority of patients to receive [chemotherapy] despite the clear demonstration of a survival benefit," states a journal editorial.

"The decision-making process is always complex," the editorialists write.

For instance, they note that patients may fear chemotherapy, and that doctors and patients must weigh chemo's pros and cons on a case-by-case basis. Those influences aren't part of the cancer database.

The editorial was written by Eric Van Cutsem, MD, PhD, and Frederico Costa, MD. They didn't work on Jessup's study.

Van Cutsem works in Leuven, Belgium at the University Hospital Gasthuisberg. Costa works in Sao Paolo, Brazil, at the Hospital Sirio Libanes.

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