Survival of Elderly Patients with Colon Cancer Treated with Chemotherapy

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The summary below is from the full report titled "Survival Associated with 5-Fluorouracil-Based Adjuvant Chemotherapy among Elderly Patients with Node-Positive Colon Cancer." It is in the 5 March 2002 issue of Annals of Internal Medicine (volume 136, pages 349-357). The authors are V Sundararajan, N Mitra, JS Jacobson, VR Grann, DF Heitjan, and AI Neugut.

What is the problem and what is known about it so far?

Colon cancer is cancer of the large intestine. If colon cancer is found in its early stages, it can often be successfully treated with surgery. If colon cancer has spread outside of the colon to the lymph nodes (node-positive colon cancer), the addition of chemotherapy that includes the drug 5-fluorouracil (5-FU) helps patients survive longer. However, such treatment is less common in patients 65 years of age and older than it is among younger patients. Some think that doctors are reluctant to advise older patients to have chemotherapy because studies of 5-FU therapy have included few older patients. It is not known whether older patients do as well after 5-FU therapy as younger patients.

Why did the researchers do this particular study?

To see whether patients with colon cancer who were at least 65 years of age and received 5-FU therapy in addition to surgery lived longer than those who were treated with surgery alone.

Who was studied?

The study included 4768 patients at least 65 years of age who received a diagnosis of node-positive colon cancer from 1992 to 1996, were covered by Medicare, and were included in a large, U.S. government-sponsored database of cancer care.

How was the study done?

The researchers determined how long patients survived and whether they received 5-FU therapy in addition to surgery. While accounting for other factors, such as noncancer illnesses, that might influence survival, the researchers then used statistical methods to see whether any survival benefit was associated with chemotherapy.

What did the researchers find?

About half of the study patients received 5-FU therapy. Patients treated with 5-FU therapy were less likely to die during the study than patients who did not get this treatment.

What were the limitations of the study?

Patients who received 5-FU may have been generally healthier, in ways that the researchers were unable to account for, than patients who did not.

What are the implications of the study?

Among patients 65 years of age and older, those who receive 5-FU therapy for node-positive colon cancer do better than those who receive surgery alone. The benefits observed in this study were similar to those reported for younger patients. Older age alone should not be a barrier to receiving 5-FU therapy for node-positive colon cancer.