Chemotherapy may be overused among young and middle-aged adults with colon cancer, with the addition of adjuvant chemotherapy not resulting in a matched survival benefit, according to a study published in JAMA Surgery.1 

The optimal management of young patients with young-onset colon cancer and the effects of available treatment on prognosis in this population remain unclear. Therefore, researchers sought to investigate whether young and middle-aged persons with colon cancer are more likely to receive postoperative systemic and, as a result, have better survival than older patients.

For the study, investigators analyzed data from 3143 patients aged 18 to 75 years with histologically confirmed primary colon adenocarcinoma diagnosed between 1998 and 2007 and included in the US Department of Defense’s Central Cancer Registry and Military Heath System medical claims databases. Of those, 58.6% were men.

Results showed that young patients aged 18 to 49 years and middle-aged patients aged 50 to 64 years had a 2- to 8-fold higher likelihood of receiving postoperative systemic chemotherapy than older patients aged 65 to 75 years across all tumor stages.

Investigators found that middle-aged patients with stage I and stage II disease were 5 times (odds ratio [OR], 5.04; 95% CI, 2.30-11.05) and 2 times (OR, 2.42; 95% CI, 1.58-3.72) more likely to receive postoperative chemotherapy compared with older adults, respectively.

In addition, both young patients (OR, 2.48; 95% CI, 1.42-4.32) and middle-aged patients (OR, 2.66; 95% CI, 1.70-4.18) were more than 2 times more likely to receive multiagent chemotherapy vs older patients.

However, the study demonstrated no significant differences in survival with regard to age among patients who underwent surgery and adjuvant systemic chemotherapy.

Reference

1. Manjelievskaia J, Brown D, McGlynn KA, et al. Chemotherapy use and survival among young and middle-aged patients with colon cancer. JAMA Surg. 2017 Jan 25. doi: 10.1001/jamasurg.2016.5050 [Epub ahead of print]