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In 1990, a conference sponsored by the National Institutes of Health (NIH) recommended that patients with stage III colon cancer receive adjuvant chemotherapy. A study of trends in chemotherapy use in the years following this recommendation reports that chemotherapy rates have increased over time, but there is still room for improvement. These results were published in the Journal of the American Medical Association.

Stage III colon cancer refers to cancer that has spread from the colon to nearby lymph nodes, but not to distant sites in the body. Patients with stage III colon cancer are generally treated with surgery to remove the cancer and later with adjuvant chemotherapy (secondary treatment given to increase the effectiveness of the primary treatment). A chemotherapy regimen typically consists of the agent 5-fluorouracil (5-FU) alone or in combination with other agents.

To assess trends over time in use of adjuvant chemotherapy, researchers evaluated a database of 85,934 patients with stage III colon cancer. Patients were identified from 560 hospitals in the U.S. between 1990 and 2002.

The results indicate that chemotherapy use increased during the years following the NIH recommendation, but that use varied by age, race, and sex.

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  • Use of adjuvant chemotherapy increased from 39% in 1991 to 64% in 2002.
  • Use of adjuvant chemotherapy was lower in black, female, and elderly patients.
  • In 1997, use of adjuvant chemotherapy improved survival by 16% compared to treatment with surgery alone. This is larger than the survival benefit of 8% that was observed in 1991.
  • Elderly patients received the same benefit from adjuvant chemotherapy as younger patients.
  • Female patients received the same benefit from adjuvant chemotherapy as male patients.
  • Black patients and those with high-grade cancers received less benefit from adjuvant chemotherapy than other patients.

The researchers conclude that use of adjuvant chemotherapy among patients with stage III colon cancer has increased since the 1990 recommendation. However, some patients, such as women and the elderly, are less likely to receive adjuvant chemotherapy in spite of a demonstrated survival benefit. Furthermore, blacks and patients with high-grade cancers did not seem to benefit from treatment to the same extent as other patients. Some of these deficits may be overcome by the development of new chemotherapy regimens that maximize effectiveness while minimizing toxicity.

Reference: Jessup JM, Stewart A, Greene FL et al. Adjuvant Chemotherapy for Stage III ColonCancer: Implications of Race/Ethnicity, Age, and Differentiation. JAMA .294:2703-2711.

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