Almost 1/3 of colon cancer patients stop chemotherapy, leading to double the death rate

First study to look at link between mortality rates from colon cancer & treatment adherence

New research from Columbia University Medical Center has found that as many as 30 percent of patients with stage III colon cancer who were prescribed six months of chemotherapy with a combination of 5-fluorouracil and leucovorin stopped their treatment prematurely. Stopping chemotherapy for colon cancer prematurely was shown to be equivalent to receiving no treatment at all. The findings add to the arsenal of reasons why colon cancer patients, and all cancer patients, need to complete their chemotherapy regimens whenever possible.

Previous studies have shown that not completing chemotherapy regimens for breast cancer is associated with shorter survival. This is the first study to look at a link between mortality rates from colon cancer and treatment adherence.

"The intuitive thinking is that if you complete most of a treatment regimen, you should get most of the treatment benefit. But these findings are significant because they indicate that completing treatment is as critical for colon cancer as it is for breast cancer and we need to do better to ensure that patients who can, complete treatment as intended," said Alfred I. Neugut, M.D., Ph.D., who led the study along with Dawn L. Hershman, M.D., M.S.

The study will be published in the May 20, 2006 issue of the Journal of Clinical Oncology (published online April 17, 2006).

The research team used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify stage III colon cancer patients who were at least 65 years of age or older, and who received one to seven months of fluorouracil (FU)-based adjuvant chemotherapy treatment.

Among the 1,579 patients who survived eight months or longer, the 1,091 (69.1 percent) who underwent five to seven months of treatment survived nearly twice as long as the 488 (30.9 percent) who received only one to four months of treatment. Patients who were older, unmarried and had comorbid conditions, were more likely to receive less than five months of treatment.

Dr. Neugut is the Myron M. Studner Professor of Cancer Research in Medicine at Columbia University Medical Center. He is also professor of epidemiology at Columbia University's Mailman School of Public Health, as well as head of Cancer Prevention and Control for the Herbert Irving Comprehensive Cancer Center, and co-director of the Cancer Prevention Center of New York Presbyterian Hospital/Columbia.

Dr. Neugut sees patients as an attending physician in medical oncology at NewYork-Presbyterian Hospital/Columbia and Harlem Hospital Center, an affiliate institution of Columbia University Medical Center.

Dr. Hershman, co-lead author, is assistant professor of medicine and epidemiology at the Columbia University College of Physicians and Surgeons in the Division of Medical Oncology. She is co-director of the Breast Program for the Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center and NewYork-Presbyterian Hospital/Columbia. Dr. Hershman is an assistant attending physician in medical oncology at New York-Presbyterian Hospital/Columbia specializing in breast cancer.

Additional members of the Columbia University Medical Center research team included: Matthew Matasar, M.D., former instructor in clinical medicine; Xiaoyan Wang, M.A., staff associate in epidemiology, Mailman School; Russell McBride, doctoral student in epidemiology, Mailman School; Judith S. Jacobson, DrPH, assistant professor of clinical epidemiology, Mailman School; Wei-Yann Tsai, Ph.D., professor of biostatistics, Mailman School; and, Victor R. Grann, M.D., MPH, clinical professor of medicine and epidemiology and health policy and management at the College of Physicians & Surgeons and Mailman School of Public Health.

The same research team recently published (Journal of Clinical Oncology, Sept. 20, 2005 issue) the first study to link treatment completion issues with race and poor survival rates. The 2005 study found that black women with early stage breast cancer were more likely than their counterparts of other races to abandon chemotherapy before completing their full course of treatment. The findings shed new light on why breast black cancer patients experience lower survival rates than other women, despite a lower incidence.

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The only accredited school of public health in New York City, and among the first in the nation Columbia University's Mailman School of Public Health provides instruction and research opportunities to more than 950 graduate students in pursuit of masters and doctoral degrees. Its students and more than 270 multi-disciplinary faculty engage in research and service in the city, nation, and around the world, concentrating on biostatistics, environmental health sciences, epidemiology, health policy and management, population and family health, and sociomedical sciences. www.mailman.hs.columbia.edu

Columbia University Medical Center provides international leadership in pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, nurses, dentists, and public health professionals at the College of Physicians & Surgeons, the College of Dental Medicine, the School of Nursing, the Mailman School of Public Health, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. www.cumc.columbia.edu


Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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