Originally published as JCO Early Release 10.1200/JCO.2005.04.5005 on April 17 2006

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Duration of Adjuvant Chemotherapy for Colon Cancer and Survival Among the Elderly

Alfred I. Neugut, Matthew Matasar, Xiaoyan Wang, Russell McBride, Judith S. Jacobson, Wei-Yann Tsai, Victor R. Grann, Dawn L. Hershman

From the Department of Medicine and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, and the Departments of Epidemiology and Biostatistics, Mailman School of Public Health, Columbia University; and the New York Presbyterian Hospital, New York, NY

Address reprint requests to Alfred I. Neugut, MD, PhD, Division of Medical Oncology, Columbia University Medical Center, 722 W 168th St, Rm 725, New York, NY 10032; e-mail: ain1{at}columbia.edu

Purpose In randomized trials, patients with stage III colon cancer who received 6 months of fluorouracil (FU)-based adjuvant chemotherapy had better survival than patients who did not. However, little is known about the predictors of, or the survival associated with, duration of chemotherapy in the community.

Patients and Methods The linked Surveillance, Epidemiology, and End Results-Medicare database was used to identify individuals 65 years of age diagnosed with stage III colon cancer between 1995 and 1999. We used logistic and Cox proportional hazards regression models to analyze factors associated with early discontinuation of FU-based chemotherapy among these elderly colon cancer patients.

Results Among 1,722 patients who received 1 to 7 months of FU-based chemotherapy, older age, being unmarried, and having comorbid conditions were associated with receiving less than 5 months of treatment. Among the 1,579 patients who survived 8 months, the 1,091 (69.1%) who received 5 to 7 months of treatment had lower overall (hazard ratio [HR], 0.59; 95%, CI 0.49 to 0.71) and colon cancer-specific (HR, 0.53; 95% CI, 0.43 to 0.66) mortality than the 488 (30.9%) who received 1 to 4 months of treatment.

Conclusion More than 30% of elderly patients who initiated FU-based chemotherapy for stage III colon cancer and survived for at least 8 months discontinued treatment early. Mortality rates among such patients were nearly twice as high as among patients who completed 5 to 7 months of treatment. If the association we observed between duration of treatment and survival is confirmed, additional investigation is warranted to determine whether dose-intensity, cumulative dose, or other factors related to receipt of full adjuvant treatment are responsible.

Supported by a K05 Award from the National Cancer Institute (NCI; Grant No. CA89155), a grant from the American Cancer Society (Grant No. RSGT-01-024-04-CPHPS), and a Department of Defense Breast Cancer Center of Excellence Award (Grant No. BC043120) to A.I.N; an R25 fellowship from the NCI (Grant No. CA94061) to M.M.; a T32 fellowship from NCI (Grant No. CA09529) to R.M.; and an American Society of Clinical Oncology Career Development Award and a K07 Award from the NCI (Grant No. CA95597) to D.L.H.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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