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More Colon Cancer Patients Get Chemotherapy

But one-third are still missing out on the therapy, study finds

TUESDAY, Dec. 6, 2005 (HealthDay News) -- Many more people with an advanced form of colon cancer are getting the chemotherapy after surgery that U.S. health officials recommend, and more are surviving because of this treatment.

However, older people and African-Americans are still more likely to miss out on the therapy, according to a decade-long analysis of national data by U.S. National Cancer Institute researchers.

Only 39 percent of patients with stage III colon cancer, in which the malignancy has spread to nearby lymph nodes, were getting adjuvant chemotherapy in 1990, one year after the National Institutes of Health said clinical studies had proved its value.

But by 2002, 64 percent of such patients were getting the treatment, according to a report in the Dec. 7 issue of the Journal of the American Medical Association.

And the five-year survival rate for those patients doubled, climbing from 8 percent to 16 percent, said the report, which was based on more than 85,000 people treated at 560 hospitals during that time.

Racial and ethnic differences in treatment were clear, the study researchers found. While nearly 70 percent of white patients with the condition received chemotherapy in 2001-2002 (as did more than 70 percent of Asian-Americans), only about 65 percent of African-Americans got the treatment.

Even still, that represents a major advance from 1990, when slightly more than 50 percent of black patients got chemotherapy, the report noted.

Age was also a major factor in treatment. Eighty-two percent of patients under the age of 60 got chemotherapy in 2001-2002, while only 39 percent of those 80 and older did. Again, though, that was an improvement from 1990, when only about 20 percent of those in the 80-and-older group got chemotherapy.

The report describes "both positive and negative issues," said Dr. Durado Brooks, director for colorectal cancer at the American Cancer Society.

"It does reinforce earlier studies that showed a survival benefit," Brooks said. "It looked at survival in a number of different groups -- gender, race, ethnicity, and age -- and found an improvement. That is all very positive."

The obvious negative is that "over a 12-year period after publication of the guidelines, only two-thirds of individuals who are eligible received treatment."

However, there remain valid reasons why some patients should not get chemotherapy, such as the presence of other major illnesses, Brooks said. But, he added, "it seems unlikely that they apply to one of every three patients."

What seems to have happened, Brooks said, is that "in many instances, patients were not offered the treatment, or it was not explained to them in a way that would allow them to make a truly informed decision. Patients should be aware that this is an option."

Dr. Deborah Schrag, an associate attending physician at Memorial Sloan-Kettering Cancer Center in New York City, said, "This suggests that we may not be doing as good a job as we should."

The study may have also underestimated the number of patients receiving chemotherapy, Schrag said. "Medically, this is a fragmented world," she said. "Patients may go off to other institutions where it is hard to track whether they get chemotherapy."

The reasons for the differences in treatment by age and ethnic group are not clear, Schrag said. "We need to know more about why people don't get treated," she said. "We need other kinds of studies than this one to figure it out."

Such studies are under way, Schrag said, notably one sponsored by the National Cancer Institute in which patients are being interviewed about their treatment.

The situation may have improved since the just-published study was completed, Brooks added. "There appears to have been a slow but steady uptrend, and it seems likely that there has been some further improvement," he said.

The availability of a new chemotherapy drug that can be given orally, rather than by injection, as older drugs require, appears to contributing to the improvement, he said.

More information

To learn more about the detection and treatment of colon cancer, visit the U.S. National Cancer Institute.

SOURCES: Durado Brooks, M.D., director for colorectal cancer, American Cancer Society, Atlanta; Deborah Schrag, M.D., associate attending physician, Memorial Sloan-Kettering Cancer Center, New York City; Dec. 7, 2005, Journal of the American Medical Association
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