A 1990 National Institutes of Health Consensus Conference recommended that patients with stage III colon cancer receive adjuvant chemotherapy.
This was due to improved survival in clinical trials in patients who received a 5-fluorouracil-based regimen.
Dr Milburn Jessup and colleagues determined whether adjuvant chemotherapy is used in the community as a standard of practice.
The research team assessed whether it improves outcome or whether it failed to benefit any specific sets of patients.
Prospective data from 85,934 patients with stage III colon cancer from 560 hospital cancer registries were entered into the National Cancer Data Base.
The researchers assessed data including standard clinical, pathological, and first course of treatment variables between 1990 and 2002.
|Compared with surgery, 5-year survival increased from 8% in 1991 to over 16% in 1997|
|Journal of the American Medical Association|
The main outcome measures included prevalence of adjuvant chemotherapy usage and 5-year survival in patients treated in hospitals in the USA.
The team noted that adjuvant chemotherapy use increased from 39% in 1991 to 64% in 2002.
However, the researchers observed that the use of adjuvant chemotherapy was lower in black, female, and elderly patients.
The researchers found that it improved 5-year survival from almost 8% in 1991 to more than 16% in 1997 compared with surgery alone.
Adjuvant chemotherapy increases survival in elderly patients as much as it does in younger patients.
However, the benefit of adjuvant chemotherapy in blacks and those with high-grade cancers is not as great.
Dr Milburn Jessup's team commented, “Adjuvant chemotherapy use has increased from 1990 to 2002 for patients with stage III colon cancer with an associated increase in 5-year survival of 16%.”
“The benefit of adjuvant chemotherapy seems to be lower in black patients and high-grade cancers.”
“Women have the same benefit but are less often treated.”
Elderly patients have the same benefit as younger patients but are less frequently treated.”
“New options for adjuvant therapy in 2004 to 2005 may further improve the outcome of patients with stage III colon cancer.”