title: Use of adjuvant chemotherapy and radiation therapy for rectal cancer among the elderly: a population-based study.
abstract: OBJECTIVE
  Combined adjuvant fluorouracil (5-FU)-based chemotherapy with radiation is now the standard of care for locally advanced rectal cancer in the United States. We investigated the use of these treatments for stages II and III rectal cancer among the elderly and the effectiveness of these treatments on a population-based scale.
  
  
  METHODS
  The linked Surveillance, Epidemiology, and End-Results-Medicare database was used to identify 1,807 Medicare beneficiaries > or = 65 years of age with stage II or III rectal cancer who underwent surgical resection between 1992 and 1996. We excluded members of a health maintenance organization in the 12 months before or 4 months after their diagnosis and those who died within 4 months of diagnosis. We used multivariate analysis to identify factors associated with combined 5-FU and radiation therapy, and propensity score methodology to determine survival benefit for those treated.
  
  
  RESULTS
  We found that 37% of patients received both adjuvant 5-FU and radiation therapy, 11% 5-FU alone, and 14% radiation alone. Decreasing age, increasing lymph node positivity, comorbid conditions, and nonblack race were associated with increased probability of treatment with 5-FU and radiation. Combined chemotherapy/radiation therapy was associated with improved survival for stage III (relative risk, 0.71; 95% confidence interval, 0.56 to 0.90), but not for stage II rectal cancer (relative risk, 0.89; 95% confidence interval, 0.70 to 1.14).
  
  
  CONCLUSIONS
  The association of combined treatment with improved survival in node-positive disease was similar to that observed in other studies. In the absence of data from well-designed randomized controlled trials, our observational data support efforts on the part of clinicians to make appropriate referrals and provide combined treatment for elderly patients with stage III rectal cancer.
authors.affiliation: Department of Medicine, Mailman School of Public Health, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. ain1@columbia.edu
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Fleischauer
authors.forename: Vijaya
authors.initials: V
authors.lastname: Sundararajan
authors.forename: Nandita
authors.initials: N
authors.lastname: Mitra
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Heitjan
authors.forename: Judith S
authors.initials: JS
authors.lastname: Jacobson
authors.forename: Victor R
authors.initials: VR
authors.lastname: Grann
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015897:Comorbidity; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil