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Stage III colon cancers: why adjuvant chemotherapy is not offered to elderly patients
T Mahoney1, Y H Kuo, A Topilow
1Department of Surgery, Robert Wood Johnson Medical School, Meridian Health System/Jersey Shore Medical Center, Neptune, NJ 07754, USA.
Hypothesis:
Adjuvant chemotherapy is not offered to elderly patients with stage III colon cancer.
Design:
A retrospective review of hospital and office records.
Setting:
A suburban community hospital.
Patients:
The medical records of 69 patients with stage III colon cancer were reviewed. All identified from the Tumor Registry at Jersey Shore Medical Center, Neptune, NJ, were included in this study.
Results:
Thirty-five patients (51%) did not receive adjuvant chemotherapy. After adjusting for age, women were 5.8 times less likely to receive chemotherapy (P = .002). Patients not receiving chemotherapy were significantly older (78.7 vs 70.4 years; P = .003) than those who received adjuvant chemotherapy. There was no relation found between the year of diagnosis and the administration of chemotherapy. There were 4 major reasons for not receiving chemotherapy: (1) not offered (n = 12, 34%), (2) refused (n = 11, 31%), (3) too old (n = 7, 20%), and (4) significant concomitant disease (n = 5, 14%).
Conclusions:
A large group of elderly patients who had been surgically treated for colon cancer and who were eligible for adjuvant chemotherapy either were not referred for treatment or refused treatment. This suggests a bias on the part of surgeons, primary care physicians, and patients against the use of chemotherapy in elderly patients.