Adjuvant chemotherapy use and adverse events among older patients with stage III colon cancer.
Adjuvant chemotherapy use and adverse events among older patients with stage III colon cancer.
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DOI：
10.1001/jama.2010.272
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发表时间：
2010-03-17
影响因子：
120.7
通讯作者：
Fletcher, Robert H.
中科院分区：
文献类型：
--
作者：
Kahn, Katherine L.;Adams, John L.;Weeks, Jane C.;Chrischilles, Elizabeth A.;Schrag, Deborah;Ayanian, John Z.;Kiefe, Catarina I.;Ganz, Patricia A.;Bhoopalam, Nirmala;Potosky, Arnold L.;Harrington, David P.;Fletcher, Robert H.
随机试验表明，辅助化疗对老年III期结肠癌患者有效。然而，老年人比年轻患者更不可能接受这种治疗，可能是因为担心副作用。评估基于明确人群背景和医疗保健系统的老年III期结肠癌患者的辅助化疗使用和结果。观察性研究辅助化疗的使用和按年龄划分的结果，使用泊松回归估计不良事件的数量，调整人口统计学和临床因素，包括合并症和化疗方案的特定因素，并记录临床详细的医疗记录回顾和患者和替代调查。五个地理上确定的地区（阿拉巴马州、爱荷华州、洛杉矶县、北加州和北卡罗莱纳州），五个综合医疗保健提供系统和15家退伍军人医院。在2003-2005年期间，675名被诊断为III期结肠癌并接受手术切除的患者随访至诊断后15个月。化疗方案，剂量，持续时间和年化平均不良事件数按年龄分层。202名75岁的患者中有一半接受了辅助化疗，而473名年轻患者中有87%接受了辅助化疗（差异37%，95% CI 30%-45%）。在辅助化疗使用者中，14名（14%）年龄在75岁以下的患者和178名（44%）年龄较小的患者接受了含有奥沙利铂的方案（差异30%，95% CI 21%-38%）。老年患者继续治疗的可能性较小。到150天，99例(40%)>= 65岁的患者和68例（25%）较年轻的患者停止化疗（差异15%，95% CI 7%-23%）。总体而言，162例（24%）患者至少有一次临床不良事件，接受辅助化疗的患者比未接受辅助化疗的患者发生更多不良事件（平均0.394比0.160，差值0.234,95% CI 0.11-0.36, p<0.001）。在辅助化疗患者中，调整后的晚期临床不良事件发生率呈反向u型分布，年龄≥75岁的患者的不良事件发生率（0.277）低于年龄较小的患者（18-54岁为0.345,55-64岁为0.519,65-75岁为0.446，任何年龄影响的p=0.008）。社区中的老年患者接受的化疗方案毒性更小，时间更短，治疗后的不良事件也比年轻患者少。这些差异对临床结果的影响尚不清楚。
Randomized trials suggest adjuvant chemotherapy is effective for elderly patients with stage III colon cancer. However, the elderly are less likely to receive this therapy than younger patients, perhaps because of concern about adverse effects. To evaluate adjuvant chemotherapy use and outcomes for older patients with stage III colon cancer from well-defined population-based settings and healthcare systems. Observational study of adjuvant chemotherapy use and outcomes by age, using Poisson regression to estimate the number of adverse events adjusted for demographic and clinical factors, including comorbid illness and specific elements of chemotherapy regimens documented with clinically detailed medical record reviews and patient and surrogate surveys. Five geographically defined regions (Alabama, Iowa, Los Angeles County, Northern California, and North Carolina), five integrated health-care delivery systems, and 15 Veterans hospitals. All 675 patients diagnosed with stage III colon cancer during 2003-2005 who underwent surgical resection were followed up to 15 months post-diagnosis. Chemotherapy regimen, dose, duration and annualized mean number of adverse events stratified by age. Half of the 202 patients >=75 years received adjuvant chemotherapy compared with 87% of 473 younger patients (diff 37%, 95% CI 30%-45%). Among adjuvant chemotherapy users, 14 (14%) of patients >=75 years and 178 (44%) of younger patients received a regimen containing oxaliplatin (diff 30%, 95% CI 21%-38%). Older patients were less likely to continue. By 150 days, 99 (40%) patients >= 65 years and 68 (25%) younger patients had discontinued chemotherapy (diff 15%, 95% CI 7%-23%). Overall, 162 (24%) patients had at least one adverse clinical event, with more events among patients treated with vs. without adjuvant chemotherapy (mean 0.394 vs. 0.160, diff 0.234, 95% CI 0.11-0.36, p<0.001). Among adjuvant chemotherapy users, adjusted rates of late clinical adverse events show a reverse U-distribution with lower rates for patients >= 75 years (0.277) versus for younger patients (0.345 for 18-54, 0.519 for 55-64, and 0.446 for 65-75 years, p=0.008 for any age effect). Older patients in the community receive less toxic and shorter chemotherapy regimens, and those treated had fewer adverse events than younger patients. The effect of these differences on clinical outcomes is not clear.
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DOI：
10.1159/000079875
发表时间：
2004-01-01
期刊：
ORL-JOURNAL FOR OTO-RHINO-LARYNGOLOGY AND ITS RELATED SPECIALTIES
影响因子：
--
作者：
Piccirillo, JF;Costas, I
通讯作者：
Costas, I
影响因子：
45.3
作者：
Keating, Nancy L.;Landrum, Mary Beth;Kahn, Katherine L.
通讯作者：
Kahn, Katherine L.
影响因子：
45.3
作者：
Ayanian, JZ;Zaslavsky, AM;Wright, WE
通讯作者：
Wright, WE
影响因子：
45.3
作者：
O'Connell, MJ;Laurie, JA;Figueredo, A
通讯作者：
Figueredo, A
影响因子：
50.5
作者：
Folprecht, G;Cunningham, D;Köhne, CH
通讯作者：
Köhne, CH