Benefits of Postoperative Chemotherapy in Colon Cancer Questioned

Although younger patients with colon cancer are more likely to receive postoperative chemotherapy than older patients, there are no added survival benefits.

In a study published in JAMA Surgery, investigators sought to determine whether there were age differences in patients administered chemotherapy, and whether it matched survival gains with recipients of postoperative chemotherapy among patients with colon cancer.

The investigators analyzed data from the Department of Defense’s Central Cancer Registry and Military Health System medical claims databases. The study included 3143 patients, aged 18 to 75 years, with histologically confirmed primary colon cancer diagnosed between 1998 and 2007. Of these patients, 59% were males.

The results of the study showed that young patients (aged 18 to 49 years) and middle-aged patients (aged 50 to 64 years) were nearly 2 to 8 times more likely to receive postoperative systemic chemotherapy compared with older patients (aged 65 to 75 years), regardless of tumor stage at diagnosis.

Young and middle-aged patients were 2.5 times more likely to receive multi-agent chemotherapy regimens, according to the study. Additionally, young and middle-aged adults who only underwent surgery had better survival compared with older patients. However, there were no significant differences in survival between young and middle-aged patients and older patients who received surgery and postoperative systemic chemotherapy.

“Most of the young patients received postoperative systemic chemotherapy, including multi-agent regimens, not currently recommends for most patients with early-stage colon cancer,” said corresponding author, Dr Kangmin Zhu. “Our findings suggest young and middle-aged adults with colon cancer may be over-treated.”

Colorectal cancer is the third leading cause of death in the United States, and accounted for more than 49,000 deaths in 2016.