Completion of therapy by Medicare patients with stage III colon cance

Physical frailty, treatment complications, and lack of social and psychological support may explain why elderly stage III colon cancer patients do not complete a course of chemotherapy after surgery, according to a study in the May 3 Journal of the National Cancer Institute.

Several trials in the late 1980s led a 1990 National Institutes of Health Consensus Panel to recommend adjuvant chemotherapy, or chemotherapy given after surgical removal of a tumor, for stage III colon cancer patients. However, despite recommendations, many patients do not initiate or complete adjuvant chemotherapy.

Sharon Dobie, M.D., of the University of Washington in Seattle, and colleagues analyzed data from 3,193 stage III colon cancer patients from the Surveillance, Epidemiology, and End Results (SEER) registries, who began adjuvant chemotherapy treatments. Patients, identified through Medicare claims, were assessed by whether they completed their chemotherapy treatment, as well as by their sociodemographic, clinical, and environmental characteristics and their physicians' characteristics.

The authors found that of the 3,193 patients who chose to initiate chemotherapy, 2,497 (78.2%) of patients completed a course of adjuvant chemotherapy. Patients who completed adjuvant chemotherapy had a reduced risk of death. An incomplete course of chemotherapeutic treatment was associated with factors related to physical frailty, treatment complications, and a lack of social and psychological support. Their physicians' characteristics did not affect whether they completed chemotherapy. African-Americans were equally likely to finish treatment as Caucasians.

The authors write, "From these findings, interventions to improve social and physical support throughout the treatment course could be implemented to test whether such support improves rates of chemotherapy completion in elderly colon cancer patients."

In an accompanying editorial, Victor R. Grann, M.D., from Columbia University's College of Physicians and Surgeons, and Franco M. Muggia, M.D., from New York University School of Medicine, suggest the paper's results verify the importance of completion of adjuvant chemotherapy for optimal survival. They write, "The findings are worthy of comment and should add to the education of medical oncologists and other physicians who participate in the management of patients undergoing curative resections for colon cancer."