Janna Manjelievskaia1, Derek Brown1, Katherine A McGlynn2, William Anderson2, Craig D Shriver3, Kangmin Zhu3. 1. John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland. 2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland. 3. John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland3Uniformed Services University, Bethesda, Maryland.
Abstract
Importance: Treatment options for patients with young-onset colon cancer remain to be defined and their effects on prognosis are unclear. Objective: To investigate receipt of adjuvant chemotherapy by age category (18-49, 50-64, and 65-75 years) and assess whether age differences in chemotherapy matched survival gains among patients diagnosed as having colon cancer in an equal-access health care system. Design, Setting, and Participants: This cohort study was based on linked and consolidated data from the US Department of Defense's Central Cancer Registry and Military Heath System medical claims databases. There were 3143 patients aged 18 to 75 years with histologically confirmed primary colon adenocarcinoma diagnosed between 1998 and 2007. This study was conducted from December 2015 to August 2016. Exposures: Patients who underwent surgery and postoperative systemic chemotherapy. Main Outcomes and Measures: The primary outcome measure of the study was overall survival of patients who only received surgery and those who received both surgery and postoperative systemic chemotherapy. Results: Of the 3143 patients, 1841 were men (58.6%). Young (18-49 years) and middle-aged (50-64 years) patients were 2 to 8 times more likely to receive postoperative systemic chemotherapy compared with older patients (65-75 years) across all tumor stages. Middle-aged patients with stage I (odds ratio, 5.04; 95% CI, 2.30-11.05) and stage II (odds ratio, 2.42; 95% CI, 1.58-3.72) disease were more likely to receive postoperative chemotherapy compared with older patients. Both groups were more likely to receive multiagent chemotherapy than were older patients (patients aged 18-49 years: odds ratio, 2.48; 95% CI, 1.42-4.32 and patients aged 50-64 years: odds ratio, 2.66; 95% CI, 1.70-4.18). Among patients who received surgery and postoperative systemic chemotherapy, no significant differences were observed in survival among age groups (the 95% CIs of hazard ratios included 1 for young and middle-aged patients compared with older patients for all tumor stages). Conclusions and Relevance: In an equal-access health care system, we found potential overuse of chemotherapy among young and middle-aged adults with colon cancer. The addition of postoperative systemic chemotherapy did not result in matched survival improvement.
Importance: Treatment options for patients with young-onset colon cancer remain to be defined and their effects on prognosis are unclear. Objective: To investigate receipt of adjuvant chemotherapy by age category (18-49, 50-64, and 65-75 years) and assess whether age differences in chemotherapy matched survival gains among patients diagnosed as having colon cancer in an equal-access health care system. Design, Setting, and Participants: This cohort study was based on linked and consolidated data from the US Department of Defense's Central Cancer Registry and Military Heath System medical claims databases. There were 3143 patients aged 18 to 75 years with histologically confirmed primary colon adenocarcinoma diagnosed between 1998 and 2007. This study was conducted from December 2015 to August 2016. Exposures: Patients who underwent surgery and postoperative systemic chemotherapy. Main Outcomes and Measures: The primary outcome measure of the study was overall survival of patients who only received surgery and those who received both surgery and postoperative systemic chemotherapy. Results: Of the 3143 patients, 1841 were men (58.6%). Young (18-49 years) and middle-aged (50-64 years) patients were 2 to 8 times more likely to receive postoperative systemic chemotherapy compared with older patients (65-75 years) across all tumor stages. Middle-aged patients with stage I (odds ratio, 5.04; 95% CI, 2.30-11.05) and stage II (odds ratio, 2.42; 95% CI, 1.58-3.72) disease were more likely to receive postoperative chemotherapy compared with older patients. Both groups were more likely to receive multiagent chemotherapy than were older patients (patients aged 18-49 years: odds ratio, 2.48; 95% CI, 1.42-4.32 and patients aged 50-64 years: odds ratio, 2.66; 95% CI, 1.70-4.18). Among patients who received surgery and postoperative systemic chemotherapy, no significant differences were observed in survival among age groups (the 95% CIs of hazard ratios included 1 for young and middle-aged patients compared with older patients for all tumor stages). Conclusions and Relevance: In an equal-access health care system, we found potential overuse of chemotherapy among young and middle-aged adults with colon cancer. The addition of postoperative systemic chemotherapy did not result in matched survival improvement.
Authors: Piero Dalerba; Debashis Sahoo; Soonmyung Paik; Xiangqian Guo; Greg Yothers; Nan Song; Nate Wilcox-Fogel; Erna Forgó; Pradeep S Rajendran; Stephen P Miranda; Shigeo Hisamori; Jacqueline Hutchison; Tomer Kalisky; Dalong Qian; Norman Wolmark; George A Fisher; Matt van de Rijn; Michael F Clarke Journal: N Engl J Med Date: 2016-01-21 Impact factor: 91.245
Authors: K K Chan; B Dassanayake; R Deen; R E Wickramarachchi; S K Kumarage; S Samita; K I Deen Journal: World J Surg Oncol Date: 2010-09-15 Impact factor: 2.754
Authors: Jessica B O'Connell; Melinda A Maggard; Jerome H Liu; David A Etzioni; Edward H Livingston; Clifford Y Ko Journal: World J Surg Date: 2004-06 Impact factor: 3.352
Authors: Jennifer M Weiss; Jessica Schumacher; Glenn O Allen; Heather Neuman; Erin O'Connor Lange; Noelle K Loconte; Caprice C Greenberg; Maureen A Smith Journal: Ann Surg Oncol Date: 2014-03-19 Impact factor: 5.344
Authors: Fa Chen; Fei Wang; Christina E Bailey; Harvey J Murff; Jordan D Berlin; Xiao-Ou Shu; Wei Zheng Journal: Am J Cancer Res Date: 2020-10-01 Impact factor: 6.166
Authors: Ilufredo Y Tantoy; Bruce A Cooper; Anand Dhruva; Janine Cataldo; Steven M Paul; Yvette P Conley; Marilyn Hammer; Kord M Kober; Jon D Levine; Christine Miaskowski Journal: Qual Life Res Date: 2018-04-21 Impact factor: 4.147
Authors: Yvonne de Man; Stef Groenewoud; Mariska G Oosterveld-Vlug; Linda Brom; Bregje D Onwuteaka-Philipsen; Gert P Westert; Femke Atsma Journal: Int J Qual Health Care Date: 2020-05-20 Impact factor: 2.038
Authors: Benjamin D Fangman; Suleyman Y Goksu; Nivan Chowattukunnel; Muhammad S Beg; Nina N Sanford; Aravind Sanjeevaiah; John Cox; Michael R Folkert; Todd A Aguilera; Joselin Mathews; Javier Salgado Pogacnik; Gaurav Khatri; Craig Olson; Patricio M Polanco; Udit Verma; David Hsiehchen; Amy Jones; Radhika Kainthla; Syed M Kazmi Journal: JCO Oncol Pract Date: 2021-01-11