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New research from Columbia University Medical Center (CUMC) has found that as many as 30 percent of patients with stage III colon cancer who were prescribed six months of chemotherapy with a combination of 5-fluorouracil and leucovorin stopped their treatment prematurely. Failing to complete the treatment was shown to be equivalent to receiving no treatment at all. The findings add to the arsenal of reasons why colon cancer patients, and all cancer patients, should complete their chemotherapy regimens when possible.
Previous studies have shown that not completing chemotherapy regimens for breast cancer is associated with shorter survival. This is the first study to look at a link between mortality rates from colon cancer and treatment adherence.
"The intuitive thinking is that if you complete most of a treatment regimen, you should get most of the treatment benefit. But these findings are significant because they indicate that completing treatment is as critical for colon cancer as it is for breast cancer, and we need to do better to ensure that patients who can, complete treatment as intended," said Alfred I. Neugut, who led the study along with Dawn L. Hershman.
The study will be published in the May 20 issue of the Journal of Clinical Oncology.
The research team used the Surveillance, Epidemiology and End Results (SEER)-Medicare database to identify stage III colon cancer patients who were at least 65 years of age or older and who received one to seven months of fluorouracil (FU)-based adjuvant chemotherapy treatment.
Among the 1,579 patients who survived eight months or longer, the 1,091 (69.1 percent) who underwent five to seven months of treatment survived nearly twice as long as the 488 (30.9 percent) who received only one to four months of treatment. Patients who were older, unmarried and had co-morbid conditions were more likely to receive less than five months of treatment.
Neugut is the Myron M. Studner Professor of Cancer Research in Medicine at CUMC. He is also professor of epidemiology at Columbia University Mailman School of Public Health, as well as head of Cancer Prevention and Control for the Herbert Irving Comprehensive Cancer Center and co-director of the Cancer Prevention Center of New York-Presbyterian Hospital (NYPH). Neugut sees patients as an attending physician in medical oncology at NYPH and Harlem Hospital Center, both affiliates of CUMC.
Hershman is assistant professor of medicine and epidemiology at the Columbia University College of Physicians & Surgeons (P&S) in the Division of Medical Oncology. She is co-director of the Breast Program for the Herbert Irving Comprehensive Cancer Center at CUMC and NYPH, where she is also an assistant attending physician in medical oncology, specializing in breast cancer.
Additional members of the CUMC research team were Matthew Matasar, former instructor in clinical medicine; Xiaoyan Wang, staff associate in epidemiology from the Mailman School; Russell McBride, doctoral student in epidemiology at Mailman; Judith S. Jacobson, assistant professor of clinical epidemiology at Mailman; Wei-Yann Tsai, professor of biostatistics at Mailman; and Victor R. Grann, clinical professor of medicine and epidemiology and health policy and management at P&S and Mailman.
The same team recently published the first study to link treatment completion issues with race and poor survival rates. The 2005 study, published in the Sept. 20, 2005 issue of the Journal of Clinical Oncology, found that black women with early-stage breast cancer were more likely than their counterparts of other races to abandon chemotherapy before completing their full course of treatment. The findings shed new light on why black breast cancer patients experience lower survival rates than other women, despite a lower incidence.
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