Senior Citizens Better Than Assumed at Enduring
Chemo After Colon Cancer Surgery
Study finds very few seniors given this option and
when they do it is for a less toxic treatment - see video. Second report
looks at cost of colon cancer care.
March 16, 2010 The walls that have held back
aggressive medical treatment for senior citizens, due to fear that they
lack the strength to withstand such treatment due to their advanced age,
continues to crumble. This week we learn that very few senior citizens
with colon cancer receive chemotherapy after surgery, but, if among the
lucky few who do, they do very well thank you.
When they do receive this treatment, however, it is
less toxic and of shorter duration than therapy younger patients
receive, but older patients experience fewer adverse events, according
to a study in the March 17 issue of the Journal of the American
Medical Association (JAMA), a theme issue on cancer.
Robert H. Fletcher, M.D., M.Sc., of Harvard Medical
School, Boston, presented the findings of the study at a JAMA media
briefing.
Randomized trials have shown reductions in cancer
death and recurrence in patients with stage III colon cancer treated
with adjuvant (supplemental - after surgery) chemotherapy. Adjuvant
chemotherapy is a grouping of chemotherapies and used to try to achieve
a cancer- free state preventing further recurrence or death over time.
Clinical trials also show that surgery and adjuvant
chemotherapy increases survival over surgery alone in selected patients
with this stage of colon cancer.
But in practice, older patients with stage III
colon cancer are much less likely to receive this treatment.
"One in two patients who were 75 years and over
received adjuvant chemotherapy as compared with 87 percent of younger
patients," according to Dr. Katherine Kahn from the Rand Coporation and
a co-author of the study. She appears in a video also released today by
JAMA
"This study tells us that amongst older patients
who receive adjuvant chemotherapy they appear to be tolerating the
treatment as well as younger patients who receive the treatment," says
Dr. Kahn
"Physicians cite the lack of randomized controlled
trials evaluating the effectiveness of adjuvant chemotherapy for
patients older than 80 years as well as comorbid [co-existing illnesses]
conditions and drug toxicities as the most common reasons for not
treating older patients with adjuvant chemotherapy," according to the
JAMA report.
Dr. Fletcher and colleagues analyzed the use of
adjuvant chemotherapy and adverse events by age, through medical records
and surveys, in a multiregional group of 675 patients diagnosed with
stage III colon cancer from 2003 through 2005, who underwent surgical
resection (removal of part of the colon).
The patients, who were followed up for as long as
15 months following their diagnosis, were from five regions (Alabama,
Iowa, Los Angeles County, northern California, and North Carolina), five
integrated health care delivery systems, and 15 Veterans Affairs
hospitals.
The researchers found that overall, 513 of 675
patients with stage III colon cancer (75 percent) received any adjuvant
chemotherapy.
Of the 202 patients 75 years and older, 101 (50
percent) received supplemental chemotherapy compared with 87 percent of
younger patients.
Patients aged 65 years and older were more likely
than younger patients to discontinue chemotherapy at all follow-up
times. For example, by 150 days, 40 percent of patients at least 65
years old had discontinued chemotherapy, compared to 25 percent of
younger patients.
Among patients receiving adjuvant chemotherapy,
adjusted rates of late clinical adverse events were lower for patients
75 years and older vs. for younger patients.
Regarding adverse events, 24 percent of patients
had at least 1 adverse event (defined as 31 days after resection and 15
months after diagnosis). These events occurred in more than twice as
many patients receiving vs. not receiving adjuvant chemotherapy.
The average number of unique adverse events was
also higher for adjuvant chemotherapy users vs. nonusers.
"Strategies to help clinicians uncertain about the
safety of adjuvant chemotherapy for older patients with comorbidity
could increase the likelihood that evidence-based chemotherapy benefits
are realized in population-based settings," the authors write.
Using decision support tools built on published
trials and population-based analyses such as these can help clinicians
predict effectiveness of chemotherapy, even for patients with comorbid
conditions and advanced age."
"Systematic monitoring of symptoms and signs among
chemotherapy users, combined with interventions to evaluate and treat
these clues, could help clinicians support patients in meeting
evidence-based treatment dosage and duration goals.
Clinicians who identify symptoms and signs early
and take steps to avoid serious adverse outcomes may enable their
patients to complete recommended treatment courses while also improving
quality of life."
"What this does is it informs patients and doctors
that if they see an older patient with stage three colon cancer they
shouldn't automatically based upon their age decide not to treat the
patient. They should work with the patient and family individually to
try to get a sense of how well that patient might tolerate the
treatment," says Dr. Kahn
Study of Seniors Evaluates Costs and Benefits
Associated With New Colon Cancer Therapies
New chemotherapy agents appear associated with
improvements in survival time for patients with metastastic colorectal
cancer, but at substantial cost, according to another study in this same
issue of JAMA.
David H. Howard, Ph.D., and colleagues at Emory
University, Atlanta, used a cancer registry database to measure trends
in life expectancy and lifetime medical costs in 4,665 patients age 66
and older diagnosed with metastastic colon cancer between 1995 and 2005.
Patients were classified according to whether they
received one or more of the six chemotherapeutic agents approved for the
treatment of metastastic colon cancer between 1996 to 2004.
Among those who received the new agents, life
expectancy increased by 6.8 months and lifetime costs increased by
$37,100, equating to a cost of $66,200 per year of life gained. After
additional adjustments, the cost for each quality-adjusted life year (a
year of life in perfect health) gained was $99,100, the authors note.
"New chemotherapeutic agents for colorectal cancer
have been singled out as examples of high-cost/low-value medical care;
no doubt they are the types of therapies that would receive close
scrutiny if Medicare and other payers were to consider
cost-effectiveness in coverage decisions," they write.
"Our estimate of the cost per quality-adjusted life
year gained, $100,000, is below most estimates of the willingness to pay
for a life-year. However, continuation of Medicare's open-ended coverage
policy for new chemotherapeutic agents and other expensive technologies
will prove difficult to sustain as costs for the program continue to
rise."
More Links of Archived Reports
Concerning the Colon and Colon Cancer
