Approximately 50 percent of elderly patients who have advanced, but not metastatic, colon cancer do not get chemotherapy after surgery. But a new statistics-based study by Columbia Health Sciences researchers reveals that elderly people with colon cancer live longer when they receive both types of treatment.
In the study, the investigators found that patients 65-years and older with colon cancer that had spread to the lymph nodes and treated with both the drug 5-fluorouracil (5-FU) and surgery had a 30 percent reduction in mortality at five years after diagnosis compared with individuals who received surgery alone. The increased longevity is similar to what patients under age 65 realize with both therapies.
This year, approximately 43,000 people will get node-positive colon cancer, two-thirds of whom are older than 65.
The study used statistical methods to analyze data from the National Cancer Institute for 4,768 patients who were at least 65-years old and who received a diagnosis of colon cancer with lymph node involvement between 1992 and 1996. Approximately half received surgery and the other half surgery and 5-FU. The mortality rate for those who received surgery alone was approximately 50 percent to 60 percent at five years, as compared with approximately 30 percent to 40 percent for those who received both treatments.
These and other comparable studies should allow doctors and patients to make better decisions about treatment for colon cancer, the researchers say. "Age should not be a deterrent for doctors and patients making the decision to treat someone with both surgery and chemotherapy," says Alfred I. Neugut, principal investigator of the study and professor of medicine at <A HREF="http://cpmcnet.columbia.edu/dept/ps/">Columbia's College of Physicians & Surgeons</A> (P&S) and epidemiology at the<A HREF="http://www.mailman.hs.columbia.edu/index.html">Mailman School of Public Health</A>. "Although the elderly often do not get treated with both surgery and chemotherapy, our study shows that they benefit from both."
The findings are being published in the March 5 issue of the Annals of Internal Medicine.
Historically, doctors may not have treated the elderly with both surgery and chemotherapy because original clinical studies from the 1980s showing the effectiveness of both therapies had been performed on younger people, the researchers surmise. Doctors rely on the medical literature to make treatment decisions.
Further, few clinical studies have been done that compare surgery with surgery and chemotherapy in the elderly population. "Future clinical trials should not have upper age restrictions," Neugut says.
Physicians also may have been fearful of offering chemotherapy in addition to surgery to elderly patients because older people tend to have other health problems. But the Annals study shows that in a sample of patients representative of the population, both treatments help increase survival.
"Doctors still have to assess, though, whether elderly patients might have other conditions in which chemotherapy might be contraindicated," Neugut says.
A problem with the study, however, is that the patients were not randomized to either the surgery or the surgery and drug group because the analysis was based on existing data, Neugut says. Patients who received the 5-FU may have been generally healthier than patients who did not get 5-FU in ways that the researchers could not determine.
Other Columbia Health Sciences researchers who participated in the study were: Vijaya Sundararajan, formerly an associate research scientist at the Mailman School of Public Health; Nandita Mitra, formerly an associate in biostatistics at Mailman; Judith Jacobson, associate professor of clinical epidemiology at Mailman; Victor Grann, associate clinical professor of medicine at P&S and associate clinical professor of epidemiology and health policy and management at Mailman, and Daniel F. Heitjan, professor of biostatistics at Mailman.
March is colorectal cancer awareness month, when cancer and medical associations try to raise awareness about getting screened for colorectal cancer. The American Cancer Society estimates about 107,300 new cases of colon cancer and 41,000 new cases of rectal cancer will be diagnosed in 2002 in the United States. Colon cancer will cause about 48,100 deaths and rectal cancer about 8,500 deaths. More than two-thirds of the deaths are preventable with simple screening and prevention methods that can catch the disease at an early stage even before chemotherapy and surgery are necessary.