Is Chemo Overused in Younger Colon Cancer Patients?
WEDNESDAY, Jan. 25, 2017 -- Young and middle-aged colon cancer patients may be getting chemotherapy more often than is warranted, a new study suggests.
"Most of the young patients received postoperative systemic chemotherapy, including multi-[drug] regimens, which are currently not recommended for most patients with early stage colon cancer," the study authors wrote. The research team was led by Dr. Kangmin Zhu from the Walter Reed National Military Medical Center in Bethesda, Md.
Overall, the findings "suggest overtreatment of young and middle-aged adults with colon cancer," Zhu and colleagues concluded.
One colon cancer expert who reviewed the study said it addresses an often difficult question.
"There is a rising trend of younger patients being diagnosed with colon cancer," said Dr. Anna Levy. She's an oncologist at Northwell Health Cancer Institute in Lake Success, N.Y.
"The premise for the paper is a valid one," she added. "When faced with a fit, young patient with cancer, the inclination of the medical oncologist is to offer treatment, which may increase their chance of living longer without disease recurrence."
But, given that chemotherapy often has side effects, is this approach being too readily used?
To find out, Zhu's team reviewed data on more than 3,100 colon cancer patients in the U.S. military who were cared for across the United States. All were aged 18 to 75, and had been diagnosed between 1998 and 2007.
Patients aged 18 to 64 were two to eight times more likely to undergo chemotherapy after surgery than people aged 65 to 75, the researchers found. Those findings were true regardless of how advanced the tumor was at diagnosis.
Young and middle-aged patients were also 2.5 times more likely to have chemotherapy using multiple drugs than older patients were, according to the researchers.
The study called the benefits of postsurgical chemotherapy for younger patients into question, as well. Among patients who had surgery without any chemotherapy, young and middle-aged adults had better survival than older adults, the research showed.
But there were no significant differences in survival between young and middle-aged and older patients who had chemotherapy after surgery, the study authors said.
However, Levy said the study did have some flaws. First, she said, the patients studied aren't reflective of the broader population.
The research "examined a very specific population, namely military personnel," she said. "This is a group of patients who are likely to be healthy at baseline and be candidates for more aggressive treatment up front."
In addition, the study didn't differentiate between low- and higher-risk stage II colon cancers, Levy added. "This is important because in clinical practice, adjuvant [postsurgical] chemotherapy is recommended for high-risk stage II, but not for low risk," she explained.
"This may account for the high percentage of both young and middle-age people with stage II being offered chemotherapy," she noted.
All of this means that the study results "have to be interpreted with caution," Levy said.
Dr. Patrick Okolo is chief of gastroenterology at Lenox Hill Hospital in New York City. He said the findings are important because "excess treatment does not improve the results of treatment, but may lead to more side effects and costs."
Okolo advises that all colon cancer patients ask their oncologist the specifics of medical staff recommendations regarding the treatment of their particular tumor. And by all means, do consider getting a second opinion, he said.
Colon and rectal cancers are the third leading cause of cancer death in the United States, the researchers said. About 134,000 new cases were diagnosed in 2016. More than 49,000 people died from these cancers in 2016 in the United States.
Colon cancer incidence and death rates among adults aged 50 and older have decreased in the United States in recent years, the researchers noted. However, the same trend hasn't occurred among patients aged 20 to 49.
The study was published online Jan. 25 in the journal JAMA Surgery.
The U.S. National Cancer Institute has more on colon cancer.
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Posted: January 2017