New study identifies factors associated with incomplete chemotherapy for colon cancer

Physical frailty, treatment complications, and lack of social and psychological support may explain why elderly stage III colon cancer patients do not complete a course of chemotherapy after surgery, according to a study in the May 3 Journal of the National Cancer Institute.

Several trials in the late 1980s led a 1990 National Institutes of Health Consensus Panel to recommend adjuvant chemotherapy, or chemotherapy given after surgical removal of a tumor, for stage III colon cancer patients. However, despite recommendations, many patients do not initiate or complete adjuvant chemotherapy.

Sharon Dobie, M.D., of the University of Washington in Seattle, and colleagues analyzed data from 3,193 stage III colon cancer patients from the Surveillance, Epidemiology, and End Results (SEER) registries, who began adjuvant chemotherapy treatments. Patients, identified through Medicare claims, were assessed by whether they completed their chemotherapy treatment, as well as by their sociodemographic, clinical, and environmental characteristics and their physicians' characteristics.

The authors found that of the 3,193 patients who chose to initiate chemotherapy, 2,497 (78.2%) of patients completed a course of adjuvant chemotherapy. Patients who completed adjuvant chemotherapy had a reduced risk of death. An incomplete course of chemotherapeutic treatment was associated with factors related to physical frailty, treatment complications, and a lack of social and psychological support. Their physicians' characteristics did not affect whether they completed chemotherapy. African-Americans were equally likely to finish treatment as Caucasians.

The authors write, "From these findings, interventions to improve social and physical support throughout the treatment course could be implemented to test whether such support improves rates of chemotherapy completion in elderly colon cancer patients."

In an accompanying editorial, Victor R. Grann,

Contact: Ariel Whitworth
Journal of the National Cancer Institute

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