Chemotherapy Overused in Young, Middle-Aged Adults With Colon Cancer

Young and middle-aged patients diagnosed with colon cancer were more likely to receive postoperative chemotherapy compared with their older-age counterparts, according to the results from a recent cohort study. However, the addition of chemotherapy in these patients did not confer any overall survival benefit compared with older patients.

“Most of the young patients received postoperative systemic chemotherapy, including multiagent regimens, which are currently not recommended for most patients with early-stage colon cancer,” wrote Janna Manjelievskaia, MPH, of Walter Reed National Military Medical Center in Bethesda, Maryland, and colleagues, in JAMA Surgery. “Our findings suggest overtreatment of young and middle-aged adults with colon cancer.”

In their study, Manjelievskaia and colleagues investigated the use of adjuvant chemotherapy by age category and assessed whether age differences in chemotherapy use matched survival gains among patients diagnosed with colon cancer.

The researchers drew on data from the US Department of Defense’s Central Cancer Registry and Military Health System medical claims databases. The study included 3,143 patients aged 18 to 75 years with histologically confirmed primary colon adenocarcinoma diagnosed between 1998 and 2007. The primary outcome measure was overall survival.

The use of postoperative chemotherapy was 2 to 8 times more common among young (18–49 years) and middle-aged (50–64 years) patients compared with patients aged 65 to 75 years, regardless of tumor stage. Middle-aged patients with stage I disease (odds ratio [OR], 5.04; 95% CI, 2.30–11.05) and with stage II disease (OR, 2.42; 95% CI, 1.58–3.72) were five times more likely and two times more likely, respectively, to receive adjuvant chemotherapy compared with older patients. The use of multiagent chemotherapy was also more likely among both young (OR, 2.48; 95% CI, 1.42–4.32) and middle-aged patients (OR, 2.66; 95% CI, 1.70–4.18) compared with older patients.

No survival difference was found by age group among patients who received surgery and postoperative systemic chemotherapy.

“While young and middle-aged adults who only underwent surgery had better survival compared with older patients, no significant differences in survival were seen between young/middle-aged and older patients who received surgery plus postoperative systemic chemotherapy after adjustment for the potential confounders,” the researchers wrote. “The study suggests that more use of chemotherapy in younger patients did not result in additional survival benefits.”

In an editorial that accompanied the study, Tonia M. Young-Fadok, MD, of the Mayo Clinic School of Medicine in Phoenix, wrote, “The study by Manjelievskaia et al invites contemplation and in-depth study. Further investigation of the discrepancies in stage II disease would be worthwhile, and additional research on the age discrepancies in stage I disease would not only be interesting but also mandatory. Colorectal cancer tumor boards frequently concentrate on the complex care of rectal cancer and metastatic colon cancer. This is also a clear call for improved oversight of chemotherapy for colon cancer.”