Abstract
Background. The clinical trials on which the treatment of advanced colorectal (CRC) is based enroll few elderly patients. Furthermore, few investigations have determined the use and outcomes of the treatment of advanced CRC in practice. This study evaluated the treatment of advanced CRC in community oncology practices, focusing on age-related differences in treatment and outcome. Methods. A national, retrospective chart review was conducted to evaluate the management of advanced CRCin 10 community practices across the U.S. All medical records of patients diagnosed with advanced CRC initiating chemotherapy treatment after January 1, 2003 through 2006 were included. The primary aim was to compare the proportion receiving doublet chemotherapy (irinotecan or oxaliplatin with a fluoropyrimi- dine) as initial therapy in young (age ≤65 years) and elderly (age >65 years) patients. Additional aims included age-based comparisons of the addition of bevacizumab to chemotherapy, overall chemotherapy use, allcause mortality, and toxicity-related events. Results. Overall, 520 patients (56% elderly) received 6,253 cycles of chemotherapy. Of the younger patients, 84% received doublet chemotherapy first-line, compared with 58% of elderly patients (p < .001). The use of each of the medications-irinotecan, oxaliplatin, and bevacizumab - was lower in elderly patients (p < .001). Independent predictors of a higher risk for mortality were age >65 (adjusted hazards ratio [HR],1.19; 95% confidence interval [CI], 1.02-1.39) and performance status score ≥2 (HR, 1.65; 95% CI, 1.41-1.91). Conclusion. Elderly patients are less likely to receive first-line doublet chemotherapy than younger patients. Age and performance status are independent predictors of treatment and overall survival.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 876-885 |
| Number of pages | 10 |
| Journal | Oncologist |
| Volume | 13 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 2008 |
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Keywords
- Bevacizumab
- Colorectal cancer
- Disparity
- Elderly
- Irinotecan
- Oxaliplatin
ASJC Scopus subject areas
- Cancer Research
- Hematology
Cite this
Disparities in the use of chemotherapy and monoclonal antibody therapy for elderly advanced colorectal cancer patients in the community oncology setting. / McKibbin, Trevor; Frei, Chris; Greene, Rebecca E.; Kwan, Peter; Simon, Jody; Koeller, Jim M.
In: Oncologist, Vol. 13, No. 8, 08.2008, p. 876-885.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Disparities in the use of chemotherapy and monoclonal antibody therapy for elderly advanced colorectal cancer patients in the community oncology setting
AU - McKibbin, Trevor
AU - Frei, Chris
AU - Greene, Rebecca E.
AU - Kwan, Peter
AU - Simon, Jody
AU - Koeller, Jim M.
PY - 2008/8
Y1 - 2008/8
N2 - Background. The clinical trials on which the treatment of advanced colorectal (CRC) is based enroll few elderly patients. Furthermore, few investigations have determined the use and outcomes of the treatment of advanced CRC in practice. This study evaluated the treatment of advanced CRC in community oncology practices, focusing on age-related differences in treatment and outcome. Methods. A national, retrospective chart review was conducted to evaluate the management of advanced CRCin 10 community practices across the U.S. All medical records of patients diagnosed with advanced CRC initiating chemotherapy treatment after January 1, 2003 through 2006 were included. The primary aim was to compare the proportion receiving doublet chemotherapy (irinotecan or oxaliplatin with a fluoropyrimi- dine) as initial therapy in young (age ≤65 years) and elderly (age >65 years) patients. Additional aims included age-based comparisons of the addition of bevacizumab to chemotherapy, overall chemotherapy use, allcause mortality, and toxicity-related events. Results. Overall, 520 patients (56% elderly) received 6,253 cycles of chemotherapy. Of the younger patients, 84% received doublet chemotherapy first-line, compared with 58% of elderly patients (p < .001). The use of each of the medications-irinotecan, oxaliplatin, and bevacizumab - was lower in elderly patients (p < .001). Independent predictors of a higher risk for mortality were age >65 (adjusted hazards ratio [HR],1.19; 95% confidence interval [CI], 1.02-1.39) and performance status score ≥2 (HR, 1.65; 95% CI, 1.41-1.91). Conclusion. Elderly patients are less likely to receive first-line doublet chemotherapy than younger patients. Age and performance status are independent predictors of treatment and overall survival.
AB - Background. The clinical trials on which the treatment of advanced colorectal (CRC) is based enroll few elderly patients. Furthermore, few investigations have determined the use and outcomes of the treatment of advanced CRC in practice. This study evaluated the treatment of advanced CRC in community oncology practices, focusing on age-related differences in treatment and outcome. Methods. A national, retrospective chart review was conducted to evaluate the management of advanced CRCin 10 community practices across the U.S. All medical records of patients diagnosed with advanced CRC initiating chemotherapy treatment after January 1, 2003 through 2006 were included. The primary aim was to compare the proportion receiving doublet chemotherapy (irinotecan or oxaliplatin with a fluoropyrimi- dine) as initial therapy in young (age ≤65 years) and elderly (age >65 years) patients. Additional aims included age-based comparisons of the addition of bevacizumab to chemotherapy, overall chemotherapy use, allcause mortality, and toxicity-related events. Results. Overall, 520 patients (56% elderly) received 6,253 cycles of chemotherapy. Of the younger patients, 84% received doublet chemotherapy first-line, compared with 58% of elderly patients (p < .001). The use of each of the medications-irinotecan, oxaliplatin, and bevacizumab - was lower in elderly patients (p < .001). Independent predictors of a higher risk for mortality were age >65 (adjusted hazards ratio [HR],1.19; 95% confidence interval [CI], 1.02-1.39) and performance status score ≥2 (HR, 1.65; 95% CI, 1.41-1.91). Conclusion. Elderly patients are less likely to receive first-line doublet chemotherapy than younger patients. Age and performance status are independent predictors of treatment and overall survival.
KW - Bevacizumab
KW - Colorectal cancer
KW - Disparity
KW - Elderly
KW - Irinotecan
KW - Oxaliplatin
UR - http://www.scopus.com/inward/record.url?scp=50649094504&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=50649094504&partnerID=8YFLogxK
U2 - 10.1634/theoncologist.2008-0061
DO - 10.1634/theoncologist.2008-0061
M3 - Article
C2 - 18695260
AN - SCOPUS:50649094504
VL - 13
SP - 876
EP - 885
JO - Oncologist
JF - Oncologist
SN - 1083-7159
IS - 8
ER -