title: Trends in the Treatment of Metastatic Colon and Rectal Cancer in Elderly Patients.
abstract: BACKGROUND
  Little is known about the use and costs of antineoplastic regimens for elderly patients with metastatic colorectal cancer (mCRC). We report population-based trends over a 10-year period in the treatment, survival, and costs in mCRC patients, stratified by ages 65-74 and 75+.
  
  
  METHODS
  We used Surveillance, Epidemiology, and End Results-Medicare data for persons diagnosed with metastatic colon (N=16117) or rectal cancer (N=4008) between 2000 and 2009. We estimated the adjusted percent of patients who received antineoplastic agents, by type, number, and their costs 12 months following diagnosis. We report the percent of patients who received 3 or more of commonly prescribed agents and estimate survival for the 24-month period following diagnosis by age and treatment.
  
  
  RESULTS
  The percentage that received 3 or more agents increased from 3% to 73% in colon patients aged 65-74 and from 2% to 53% in patients 75+. Similar increases were observed in rectal patients. Average 1-year costs per patient in 2009 were $106,461 and $102,680 for colon and rectal cancers, respectively, reflecting an increase of 32% and 20%, for patients who received antineoplastic agents. Median survival increased by about 6 and 10 months, respectively, for colon and rectal patients aged 65-74 who received antineoplastic agents, but an improvement of only 1 month of median survival was observed for patients 75+.
  
  
  CONCLUSIONS
  Expensive multiple agent regimens are increasingly used in older mCRC patients. For patients aged 64-75 years, these treatments may be associated with several months of additional life, but patients aged 75+ may incur considerable expense without any survival benefit.
authors.affiliation: *Department of Health Systems, Management, and Policy, Colorado Comprehensive Cancer Center, University of Colorado, Aurora, CO †Health Services and Economics Branch, National Cancer Institute, Bethesda ‡Information Management Services, Rockville, MD §Departments of Medicine and Health Care Policy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA.
authors.forename: Cathy J
authors.initials: CJ
authors.lastname: Bradley
authors.forename: K Robin
authors.initials: KR
authors.lastname: Yabroff
authors.forename: Joan L
authors.initials: JL
authors.lastname: Warren
authors.forename: Christopher
authors.initials: C
authors.lastname: Zeruto
authors.forename: Neetu
authors.initials: N
authors.lastname: Chawla
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Lamont
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use*; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009362:Neoplasm Metastasis; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D018426:SEER Program; D016019:Survival Analysis; D014481:United States
chemical_list: D000970:Antineoplastic Agents