Comparative Effectiveness of Different Chemotherapeutic Regimens on Survival of People Aged 66 and Older with Stage III Colon Cancer: A "Real World" Analysis Using Surveillance, Epidemiology, and End Results-Medicare Data

• Published in: Journal of the American Geriatrics Society (JAGS) 2011-09, Vol.59 (9), p.1717-1723
• Main Authors: Hsiao, Fei-Yuan, Mullins, C. Daniel, Onukwugha, Ebere, Pandya, Naimish, Hanna, Nader
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Camptothecin - administration & dosage; Camptothecin - analogs & derivatives; Cancer; Chemotherapy; Chemotherapy, Adjuvant; clinical trials; colon cancer; Colonic Neoplasms - drug therapy; Colonic Neoplasms - mortality; Colonic Neoplasms - surgery; Colorectal cancer; Comparative Effectiveness Research; Comparative studies; Effectiveness; Epidemiology; Female; Fluorouracil - administration & dosage; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; irinotecan; Leucovorin - administration & dosage; Male; Medical sciences; Miscellaneous; Mortality; Older people; Organoplatinum Compounds - administration & dosage; oxaliplatin; Proportional Hazards Models; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; SEER Program; SEER-Medicare; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; survival; Survival Analysis; Treatment Outcome; Tumors; United States
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2011.03501.x

OBJECTIVES: To compare the effectiveness and utilization trends of irinotecan (IRI)‐based and oxaliplatin (OX)‐based regimens with those of 5‐fluorouracil and leucovorin (5FU/LV) alone in people aged 66 and older with Stage III colon cancer. DESIGN: Retrospective cohort study. SETTING: Data from the Surveillance, Epidemiology, and End Results (SEER)–Medicare data. PARTICIPANTS: People with Stage III surgically resected colon cancer who received adjuvant chemotherapy were categorized into 5FU/LV‐alone (n=3,581), OX‐based regimen (n=814), and IRI‐based regimen (n=219) subgroups. MEASUREMENTS: Multivariable Cox proportional hazards models examined the effect of chemotherapies on overall survival, colon cancer–specific survival, and non‐colon cancer–specific survival. RESULTS: Use of the OX‐based regimen increased, and use of the 5FU/LV‐alone and IRI‐based regimens decreased over time. OX was statistically significantly associated with longer overall survival (hazard ratio (HR)=0.73, 95% confidence interval (CI)=0.62–0.86, P