Chemotherapy use and adoption of new agents is affected by age and comorbidities in patients with metastatic colorectal cancer
Open Access
- 5 July 2016
- Vol. 122 (20), 3191-3198
- https://doi.org/10.1002/cncr.30077
Abstract
BACKGROUND The treatment of metastatic colorectal cancer (mCRC) has changed substantially in the last 2 decades, but to the authors' knowledge, the effect of age and comorbidities on chemotherapy use has not been well studied to date. METHODS Patients with mCRC who were being treated with 5‐fluorouracil (5‐FU)‐based chemotherapy between January 1995 to December 2009 were studied using the LifeLink Health Plan Claims Database. The cohort was divided into older (aged >70 years) and younger (aged ≤70 years) patients. The Charlson Comorbidity Index (CCI) was used to assess comorbidity burden. The Wilcoxon and chi‐square tests were used in univariate and logistic regression in multivariate analyses. RESULTS A total of 16,087 patients were identified, with 24% of the patients who were receiving chemotherapy being aged >70 years. The percentage of patients with a CCI >1 receiving chemotherapy increased over time (14% in 1996 vs 40% after 2004; P<.05). Older patients were less likely to receive treatment with >2 agents compared with younger patients (15% vs.22% and 11% vs.16%, respectively, in 2003 and 2009; P<.001). After approval by the US Food and Drug Administration in 1998, the use of irinotecan was lower in older compared with younger patients, a difference that resolved by 2002 (15% vs 38% [P<.05]; 62% in both groups [P = .9], respectively). Similarly, oxaliplatin was used more frequently in younger patients in 2003 (22% vs 15%; P<.05), with a decrease in this difference noted by 2009 (64% vs 60%; P = .95). On multivariate analysis, older age (odds ratio, 0.65; P<.001) and a CCI >1 (odds ratio, 0.84; P<.001) were found to be associated with a lower likelihood of receiving combination chemotherapy. CONCLUSIONS In this commercially insured population, the percentage of older patients treated for mCRC was low, and the rate of chemotherapy adoption was found to lag behind that of younger patients. However, the percentage of older patients with comorbidities receiving therapy increased over time. Cancer 2016;122:3191–8. © 2016 American Cancer Society.Keywords
Funding Information
- National Cancer Institute (3P30CA006927-47S4, K07CA136995)
- American Cancer Society (IRG 92-027-15)
- Cancer Center (P30CA43703)
This publication has 26 references indexed in Scilit:
- Uptake of Oxaliplatin and Bevacizumab for Treatment of Node-Positive and Metastatic Colon CancerJournal of Oncology Practice, 2012
- Uptake and Economic Impact of First-Cycle Colony-Stimulating Factor Use During Adjuvant Treatment of Breast CancerJournal of Clinical Oncology, 2012
- Adoption of Intensity-Modulated Radiation Therapy for Breast Cancer in the United StatesJNCI Journal of the National Cancer Institute, 2011
- Cost Implications of the Rapid Adoption of Newer Technologies for Treating Prostate CancerJournal of Clinical Oncology, 2011
- A retrospective analysis illustrating the substantial clinical and economic burden of prostate cancerProstate Cancer and Prostatic Diseases, 2010
- Incidence and Costs of Treatment-Related Complications Among Patients With Advanced Squamous Cell Carcinoma of the Head and NeckJAMA Otolaryngology–Head & Neck Surgery, 2009
- Referral to Medical Oncology: A Crucial Step in the Treatment of Older Patients with Stage III Colon CancerThe Oncologist, 2006
- Irinotecan in Combination With Fluorouracil in a 48-Hour Continuous Infusion As First-Line Chemotherapy for Elderly Patients With Metastatic Colorectal Cancer: A Spanish Cooperative Group for the Treatment of Digestive Tumors StudyJournal of Clinical Oncology, 2005
- Efficacy of 5-fluorouracil-based chemotherapy in elderly patients with metastatic colorectal cancer: a pooled analysis of clinical trialsAnnals Of Oncology, 2004
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987