title: Increased adjuvant treatment and improved survival in elderly stage III colon cancer patients in The Netherlands.
abstract: BACKGROUND
  We determined to what extent patients with colon cancer stage III ≥ 75 years received adjuvant chemotherapy and the impact on overall and disease-specific survival.
  
  
  METHODS
  Data from The Netherlands Cancer Registry on all 8051 patients with colon cancer stage III ≥ 75 years diagnosed in 1997-2009 were included. Trends in adjuvant chemotherapy administration were analysed and multivariable overall and disease-specific survival analyses were performed.
  
  
  RESULTS
  The proportion of stage III colon cancer patients ≥ 75 years who received adjuvant chemotherapy increased from 12%in 1997-2000 to 23% in 2007-2009 (P < 0.0001), with a marked age gradient and large geographic variation. Five-year overall survival increased over time from 28% in 1997-2000 to 35% in 2004-2006 (P < 0.0001). Sixty percent of patients died of colorectal cancer. Adjuvant chemotherapy was the strongest positive predictor of survival in this retrospective study (hazard ratio = 0.5; 95% confidence interval: 0.4-0.5).
  
  
  CONCLUSIONS
  There has been an increase in administration of adjuvant chemotherapy to elderly patients with stage III colon cancer in The Netherlands since 1997. Survival of elderly patients with stage III colon cancer increased over time, at least partly due to stage migration. The large effect of adjuvant chemotherapy on survival in this study is likely to be associated with the selection of fitter patients for adjuvant treatment.
authors.affiliation: Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven. Electronic address: research@ikz.nl.
authors.forename: L N
authors.initials: LN
authors.lastname: van Steenbergen
authors.affiliation: Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus University Medical Centre, Rotterdam.
authors.forename: V E P P
authors.initials: VEPP
authors.lastname: Lemmens
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven.
authors.forename: H J T
authors.initials: HJT
authors.lastname: Rutten
authors.affiliation: Department of Internal Medicine, Medisch Spectrum Twente, Enschede.
authors.forename: A N M
authors.initials: ANM
authors.lastname: Wymenga
authors.affiliation: Department of Internal Medicine, LUMC, Leiden.
authors.forename: J W R
authors.initials: JWR
authors.lastname: Nortier
authors.affiliation: Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Clinical Epidemiology, Viecuri Medical Centre, Venlo, The Netherlands.
authors.forename: M L G
authors.initials: MLG
authors.lastname: Janssen-Heijnen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009426:Netherlands; D012189:Retrospective Studies; D016019:Survival Analysis