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According to an article recently published in the journal Cancer, a delay in chemotherapy longer than three months following surgery is associated with worse outcomes for elderly patients with colorectal cancer. Fortunately, these delays are not common.

Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Early colorectal cancer refers to cancer that has not spread from its site of origin to distant sites in the body.

Standard treatment for early colorectal cancer typically includes surgery followed by chemotherapy and/or radiation therapy. Chemotherapy following surgery, referred to as adjuvant therapy, is used to kill cancer cells that may be remaining in the body. The use of chemotherapy reduces the risk of a cancer recurrence and ultimately improves survival in these patients. It is recommended that adjuvant chemotherapy is started 30–40 days after surgery.

Researchers from Columbia University recently conducted a study to evaluate the potential effects of timing of chemotherapy in patients with early colorectal cancer. The researchers evaluated data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare data including over 4,000 patients who were older than 65 years of age. Patients received adjuvant chemotherapy for Stage III colon cancer between 1992 and 1999.

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  • 26% of patients received adjuvant chemotherapy within one month of surgery, 55% between one and two months of surgery, 10% in the third month following surgery, and 10% more than three months following surgery.
  • Increased age, other existing medical conditions, and being unmarried were associated with a delay in chemotherapy.
  • Patients treated with adjuvant chemotherapy more than three months following surgery experienced a 60% overall increased risk of death and a 50% increased risk of death from their cancer.
  • Other factors associated with overall survival were increased age, other existing medical conditions, more aggressive types of cancer, the presence of cancer spread to four or more lymph nodes, and surgery performed at a non-teaching hospital.

The researchers concluded that a delay in chemotherapy longer than three months significantly reduces overall survival among elderly patients with Stage III colorectal cancer. Patients with colorectal cancer should speak with their physician regarding their individual risks and benefits of the timing of adjuvant chemotherapy.

Reference: Hershman D, Hall MJ, Wang X, et al. Timing of adjuvant chemotherapy initiation after surgery for Stage III colon cancer. Cancer. 2006;107:2581-2588

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