Trends in the Treatment of Metastatic Colon and Rectal Cancer in Elderly Patients
Trends in the Treatment of Metastatic Colon and Rectal Cancer in Elderly Patients
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DOI：
10.1097/mlr.0000000000000510
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发表时间：
2016-05-01
期刊：
影响因子：
3
通讯作者：
Lamont, Elizabeth B.
中科院分区：
文献类型：
--
作者：
Bradley, Cathy J.;Yabroff, K. Robin;Lamont, Elizabeth B.
背景：对于老年转移性结直肠癌(MCRC)患者抗肿瘤方案的使用和费用知之甚少。我们报告了10年间多发性结直肠癌患者的治疗、生存和费用的基于人群的趋势，按65-74岁和75岁以上的年龄分层。方法：我们使用了2000年至2009年间诊断为转移性结肠癌(N=16117)或直肠癌(N=4008)的患者的监测、流行病学和最终结果-医疗保险数据。我们估计了接受抗肿瘤药物治疗的患者的调整百分比，按类型、数量和诊断后12个月的费用计算。我们报告了接受3种或更多常用药物治疗的患者的百分比，并根据年龄和治疗情况估计了患者在确诊后24个月内的生存情况。结果：在65-74岁的结肠癌患者中，接受3种或更多药物治疗的比例从3%增加到73%，在75岁以上的患者中从2%增加到53%。在直肠患者中也观察到类似的增加。2009年，结肠癌和直肠癌患者的1年平均费用分别为106,461美元和102,680美元，对于接受抗肿瘤药物治疗的患者来说，这两个数字分别增加了32%和20%。接受抗肿瘤药物治疗的65-74岁的结肠癌和直肠癌患者的中位生存期分别增加了约6个月和10个月，而75岁以上的患者中位生存期仅提高了1个月。结论：昂贵的多药方案越来越多地用于老年mCRC患者。对于-75岁的患者，这些治疗可能与几个月的额外生命相关，但75岁以上的患者可能会产生相当大的费用，而没有任何生存益处。
Background: Little is known about the use and costs of antineoplastic regimens for elderly patients with metastatic colorectal cancer (mCRC). We report population-based trends over a 10-year period in the treatment, survival, and costs in mCRC patients, stratified by ages 65-74 and 75+.Methods: We used Surveillance, Epidemiology, and End Results-Medicare data for persons diagnosed with metastatic colon (N = 16117) or rectal cancer (N = 4008) between 2000 and 2009. We estimated the adjusted percent of patients who received antineoplastic agents, by type, number, and their costs 12 months following diagnosis. We report the percent of patients who received 3 or more of commonly prescribed agents and estimate survival for the 24-month period following diagnosis by age and treatment.Results: The percentage that received 3 or more agents increased from 3% to 73% in colon patients aged 65-74 and from 2% to 53% in patients 75+. Similar increases were observed in rectal patients. Average 1-year costs per patient in 2009 were $106,461 and $102,680 for colon and rectal cancers, respectively, reflecting an increase of 32% and 20%, for patients who received antineoplastic agents. Median survival increased by about 6 and 10 months, respectively, for colon and rectal patients aged 65-74 who received antineoplastic agents, but an improvement of only 1 month of median survival was observed for patients 75+.Conclusions: Expensive multiple agent regimens are increasingly used in older mCRC patients. For patients aged 64-75 years, these treatments may be associated with several months of additional life, but patients aged 75+ may incur considerable expense without any survival benefit.