A 10-year study has found that the rate of elderly patients receiving 3 or more treatments for metastatic colorectal cancer has increased substantially from 2000 to 2009, but that added agents may not lead to improved survival in all cases.
The treatment of colorectal cancer is often associated with a number of adverse side effects and can significantly reduce a patient’s overall quality of life. Additionally, adding more treatments to a regimen can significantly increase cost burden to patients, making it necessary to ensure that all treatments decisions are based on the highest-quality evidence.
In an article published in Medical Care, Cathy J Bradley, PhD, University of Colorado Cancer Center (Aurora, CO), led a study to investigate trends of treatment in elderly patients with metastatic colon and rectal cancers. For the study, researchers identified more than 20,000 Medicare patients diagnosed with metastatic colon (n = 16,117) or rectal (n = 4008) cancer between the years of 2000 and 2009. They then evaluated the proportion of patients who received 3 or more commonly prescribed drugs, comparing their survival rates and costs for the 24-month period following diagnosis with those who received fewer treatments.
In patients with colon cancer, the proportion of patients aged 65–74 years that received 3 or more agents increased from 3% to 73% and, in those aged 75 years and older, from 2% to 53%. Similar trends were observed for patients with rectal cancer.
Costs also increased by 32% and 20% for patients with colon and rectal cancers, respectively. Further, the researchers found that a majority of the cost increases were being borne by patients: patients paid ~$16,000 in out-of-pocket expenses in 2009 compared with just $11,000 in 2000.
At the same time, whereas median overall survival was about 8 months greater among patients aged 65-74 years that received multi-agent regimens compared with those that did not, the same benefit was not evident in patients 75 years of age or older.
Therefore, researchers concluded that, although multiple-agent regimens are increasing in use among older patients with colorectal cancer, these added agents only improve survival for patients aged 64-75 years while older patients incur considerable expenses without any significant survival benefit.
