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Survival Associated with 5-Fluorouracil–Based Adjuvant Chemotherapy among Elderly Patients with Node-Positive Colon Cancer

Vijaya Sundararajan, MD, MPH; Nandita Mitra, PhD; Judith S. Jacobson, DrPH; Victor R. Grann, MD, MPH; Daniel F. Heitjan, PhD; and Alfred I. Neugut, MD, PhD
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From Joseph L. Mailman School of Public Health, the Herbert Irving Comprehensive Cancer Center, and College of Physicians and Surgeons, Columbia University, New York, New York.

Disclaimer: Although this study used the linked seer–medicare database, the interpretation and reporting of these data are solely the authors' responsibility.

Acknowledgments: The authors acknowledge the efforts of the Applied Research Branch, Division of Cancer Prevention and Population Science, National Cancer Institute; the Office of Information Services and the Office of Strategic Planning, Health Care Financing Administration; Information Management Services, Inc; and the SEER Program tumor registries in the creation of the seer–medicare database.

Grant Support: By a grant from the American Cancer Society (RSGHP-01-024-01-CCE). Dr. Grann is the recipient of an American Cancer Society Award (CRTG-98-260-01). Dr. Mitra was supported by a predoctoral fellowship from the National Cancer Institute (T32 CA09529). Dr. Neugut is the recipient of a K05 award from the National Cancer Institute (CA89155). Drs. Heitjan and Neugut were supported in part by NCI P30 CA13696.

Requests for Single Reprints: Alfred I. Neugut, MD, PhD, Division of Medical Oncology, New York Presbyterian Hospital, PH 18-127, 630 West 168th Street, New York, NY 10032; e-mail, ain1@columbia.edu.

Current Author Addresses: Dr. Sundararajan: Department of Epidemiology and Preventive Medicine, 553 Kilda Street, Alfred Hospital, Monash Medical School, Melbourne, Victoria 3181, Australia.

Drs. Mitra and Heitjan: Department of Biostatistics, Joseph L. Mailman School of Public Health, Columbia University, 600 West 168th Street, New York, NY 10032.

Dr. Jacobson: Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, 600 West 168th Street, New York, NY 10032.

Drs. Grann and Neugut: Division of Medical Oncology, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032.

Author Contributions: Conception and design: V. Sundararajan, J.S. Jacobson, V.R. Grann, A.I. Neugut.

Analysis and interpretation of the data: V. Sundararajan, N. Mitra, V.R. Grann, D.F. Heitjan, A.I. Neugut.

Drafting of the article: V. Sundararajan, N. Mitra, V.R. Grann, A.I. Neugut.

Critical revision of the article for important intellectual content: V. Sundararajan, N. Mitra, J.S. Jacobson, V.R. Grann, D.F. Heitjan, A.I. Neugut.

Final approval of the article: V. Sundararajan, N. Mitra, J.S. Jacobson, V.R. Grann, D.F. Heitjan, A.I. Neugut.

Provision of study materials or patients: A.I. Neugut.

Statistical expertise: N. Mitra, D.F. Heitjan.

Obtaining of funding: V. Sundararajan, A.I. Neugut.

Collection and assembly of data: V. Sundararajan.

Ann Intern Med. 2002;136(5):349-357. doi:10.7326/0003-4819-136-5-200203050-00007
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Of the original group of 4962 patients with node-positive colon cancer, 194 (3.91%) received chemotherapy that did not include 5-FU. These patients were excluded from further analysis. Table 1 shows the demographic and clinical characteristics of the remaining 4768 patients and the proportions treated with 5-FU. Overall, 52% of patients received 5-FU. Table 2 compares treated and untreated patients with respect to age, year of diagnosis, ethnicity, sex, urban residence, specific SEER cancer registry site, number of lymph nodes involved with tumor, tumor grade, extent of disease, and comorbid disease status. All of these covariates were predictors of treatment with 5-FU and were unequally distributed between the treated and untreated groups. With adjustment for propensity score, all covariates (except for age) were balanced within each stratum. Only 11% of patients in quintile 1 (mean age, 87 years) but 83% of those in quintile 5 (mean age, 69 years) were treated (Table 3). Therefore, age was strongly associated with treatment.

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Grahic Jump Location
Survival of patients with node-positive colon cancer.

The solid line indicates patients treated with 5-fluorouracil; the dotted line indicates those not treated with 5-fluorouracil.

Grahic Jump Location




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Summary for Patients

Survival of Elderly Patients with Colon Cancer Treated with Chemotherapy

The summary below is from the full report titled “Survival Associated with 5-Fluorouracil-Based Adjuvant Chemotherapy among Elderly Patients with Node-Positive Colon Cancer.” It is in the 5 March 2002 issue of Annals of Internal Medicine (volume 136, pages 349-357). The authors are V Sundararajan, N Mitra, JS Jacobson, VR Grann, DF Heitjan, and AI Neugut.


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