USU: Younger Colon Cancer Patients Appear Overtreated

BETHESDA, MD — While young and middle-aged patients are much more likely to receive postoperative chemotherapy than older patients, they don’t appear to survive any longer from colon cancer, a new study reported.

A JAMA Surgery article recently noted that incidence and mortality rates among adults age 50 and older have decreased recently in the United States—but not for patients ages 20 to 49. Furthermore, according to study authors from the Uniformed Services University of the Health Sciences (USU), treatment options aren’t always clear for patients with young-onset colon cancer, nor are the effects on prognosis well-quantified.1

For the study, researchers examined whether there were age differences in receiving chemotherapy and whether there were matched survival gains with the receipt of postoperative chemotherapy among colon cancer patients. To do that, they analyzed data from the DoD’s Central Cancer Registry and MHS medical claims databases, focusing on 3,143 patients, 59% male, ages 18 to 75, and with histologically confirmed primary colon cancer diagnosed between 1998 and 2007.

Results indicated that young (18-49 years) and middle-aged (50-64 years) patients were two to eight times more likely to receive postoperative systemic chemotherapy, compared with older patients (65-75 years), regardless of tumor stage at diagnosis.

In addition, young and middle-aged adults were 2.5 times more likely to receive multi-agent chemotherapy regimens. Undergoing surgery alone improved survivability for young and middle-aged adults compared to older patients, but the researchers found no significant differences in survival between young/middle-aged and older patients who also received postoperative systemic chemotherapy.

“Most of the young patients received post-operative systemic chemotherapy, including multi-agent regimens, not currently recommended for most patients with early-stage colon cancer,” said lead researcher Kangmin Zhu, MD PhD, professor in USU’s Department of Preventive Medicine and Biostatistics, “Our findings suggest young and middle-aged adults with colon cancer may be over-treated.”

  1. Manjelievskaia J, Brown D, McGlynn KA, Anderson W, Shriver CD, Zhu K. Chemotherapy Use and Survival Among Young and Middle-Aged Patients With Colon Cancer. JAMA Surg. 2017 Jan 25. doi: 10.1001/jamasurg.2016.5050. [Epub ahead of print] PubMed PMID: 28122072.

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