Adjuvant chemotherapy for colon carcinoma with positive lymph nodes: use and benefit in routine health care practice.
In 1990, an international consensus was reached on the efficacy of adjuvant chemotherapy for lymph node positive (stage III) colon carcinoma (CC). This study evaluates the use and benefit of such therapy in routine health care practice. The study includes all patients with stage III CC treated by putative curative surgery (n = 182) recorded at the Geneva cancer registry between 1990 and 1996. Factors modifying chemotherapy use were determined by logistic regression, considering patients with chemotherapy as cases (n = 55) and others as controls (n = 127). The effect of chemotherapy on the 5-year survival was evaluated by the Cox model. Analyses were adjusted for possible confounders. The use of chemotherapy increased over the period (P(trend) < 0.001). Age strongly modulated chemotherapy use. In 1996, 54% of eligible patients received chemotherapy, this proportion fell to 13% after age 70. Decisions to use chemotherapy significantly depended on stage, grade and cancer site. The chance to be treated was non-significantly lower among individuals of low social class, widowed and foreigners. Chemotherapy significantly decreased mortality rates (Hazard ratio: 0.35, 95%CI: 0.18-0.68), independently of the prognostic factors and with similar benefit regardless of stage and age group. Strong beneficial effect of adjuvant chemotherapy on stage III CC can be achieved in routine practice. However, this study shows that it is probably not optimally utilised in Switzerland, particularly among the elderly.
Bouchardy
C
C
Geneva Cancer Registry, Institute for Social and Preventive Medicine, 55 boulevard de la Cluse, Geneva, 1205, Switzerland.
Queneau
P E
PE
Fioretta
G
G
Usel
M
M
Zellweger
M
M
Neyroud
I
I
Raymond
L
L
de Wolf
C
C
Sappino
A P
AP
D000328:Adult; D000367:Age Factors; D000368:Aged; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D004641:Emigration and Immigration; D005260:Female; D006306:Health Surveys; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012042:Registries; D012923:Social Class; D016019:Survival Analysis; D013557:Switzerland