Colon cancer treatment in elderly patients often less aggressive than recommended

The new findings of a major initiative on the quality of cancer care in the United States show that patients with a common type of cancer of the colon, particularly older patients often do not receive aggressive chemotherapy showing research is associated with improved survival.

Led by researchers at UCLA and the Rand Corporation, a nonprofit research, the study is among the first to determine how the results of specialized research tests are applied in various practices in the community, where a greater variety of patients are treated. The findings appear in the March 17 edition of the Journal of American Medical Association, dedicated to the development of cancer care.

The study indicates that older patients, and to some extent young people often do not receive recommended care based on the results of clinical trials. The results show that patients with stage 3 colon cancer – time when the cancer has spread to lymph nodes – have less recurrence of cancer and improved survival if they receive chemotherapy to “lock” in a state free of cancer after surgical removal of cancer. Studies also show that adjuvant chemotherapy improves the outlook for patients in all age groups.

“Our team found that patients, especially elderly patients in the communities have received the attention it is different in many aspects of what is recommended in tests in specialized research settings,” said Dr. Katherine L. Kahn, Professor of Medicine, Division of General Internal Medicine and Health Services at the David Geffen School of Medicine at UCLA. “A better understanding of why this is important to improve care for this group of patients.”

The results of the research results of cancer treatment and follow-up study, a multicenter project to assess the care and outcomes for patients newly diagnosed with colorectal cancer screening. The project was designed to examine the treatment of colon cancer care centers across America.

“Given that patients participating in trials of new cancer treatments tend to be younger, healthier and less socioeconomically diverse cancer patients in general, is important to see how new treatments have been adopted within the community where there is a greater variety of patients, “said Kahn, who is also a researcher at the UCLA Jonsson Comprehensive Cancer Center and principal investigator on natural RAND.

The study included patients who spoke English, Spanish or Chinese.

Once identified 4713 patients with colorectal cancer, researchers analyzed 675 patients received care, including 202 people aged 75 years who were diagnosed between 2003 and 2005 with Stage 3 had colon cancer and underwent surgery to remove tumors and lymph nodes where cancer has been detected.

Researchers have found that the use of adjuvant chemotherapy in various contexts are different recommendations for clinical trials in four ways:

* Despite the evidence from trials showing better outcomes for patients receiving adjuvant chemotherapy regardless of age, only 50 percent of patients over 75 years received adjuvant chemotherapy.
* Starting doses of chemotherapy were lower than in the standard regimens of 18 percent of patients.
* Older patients were less likely to receive the highest of chemotherapy, which has been shown in clinical trials to be more effective in improving survival by 14 percent of elderly patients, compared with 44 percent of younger patients have received this type of chemotherapy.
* Contrary to the recommendations that the course of adjuvant chemotherapy for six months, only two thirds of the patients were still treated with adjuvant chemotherapy for six months: 40 percent of older patients and 25 percent of young patients had stopped treatment for five months.

Although the study found that treatment in the community was not consistent with the recommendations of clinical trials, researchers do not know whether these differences lead to worse results over time.

“Among the patients, older patients did not have more adverse outcomes in the years following the diagnosis of cancer than younger patients, even taking into account the additional illnesses that older patients are more likely to have,” said Kahn.

Older patients with colon cancer who received chemotherapy may fare as well because those selected for treatment were stronger, or because they had received less intensive chemotherapy, although the RAND-UCLA study also represented the care of patients disease and the date of commencement of chemotherapy, the intensity and duration.

The researchers plan to continue with cancer patients to determine whether lower doses and shorter courses of treatment in community practice settings, compared with the tests, the results are comparable especially in elderly patients treated in different contexts. Also examine whether the modified treatments affect cancer recurrence and disease-free survival, as expected based on the evidence of the trial.

“We use chemotherapy to prevent recurrence and prolong survival without disease,” said Kahn. “Right now we do not know if these new treatments are associated with a significantly lower rate of recurrence and better survival than was observed with the use of adjuvant chemotherapy trials.”

The researchers say the study provides important information on the many steps in the translation of science from the search parameters to the configuration of the Community Office, where physicians see the majority of patients with colon cancer.

“It’s important to see whether new treatments supported by the research may be used in communities where there are different groups of patients, not just the young and strong who usually volunteer for research studies,” said Kahn.

Patients in the cancer study were extracted from three positions: five zones based on the population of Alabama, Iowa, County of Los Angeles, Northern California and North Carolina, five integrated systems of health care and 15 veterans hospitals . They were among 10,061 patients and their caregivers who have participated in federal funding for cancer treatment and research results surveillance study of colorectal cancer and lung cancer.