%0 Journal Article %1 Sundararajan2002 %A Sundararajan, V %A Mitra, N %A Jacobson, J S %A Grann, V R %A Heitjan, D F %A Neugut, A I %D 2002 %J Annals of Internal Medicine %K 80ANDOVER;#ANTIMETABOLITES ADJUVANT;#COLONICNEOPLASMS/DRUGTHERAPY/MORTALI AGEFACTORS;AGED;AGED ANTINEOPLASTIC/THERAPEUTICUSE;CHEMOTHERAPY FACTUAL;#FLUOROURACIL/THERAPEUTICUSE;HUMANS;L NON-U.S.GOV'T;RESEARCHSUPPORT P.H.S;RETROSPECTIVESTUDIES;SENSITIVITYANDSPE U.S.GOV'T %N 5 %P 349-357 %T Survival associated with 5-fluorouracil-based adjuvant chemotherapy among elderly patients with node-positive colon cancer %V 136 %X BACKGROUND: Randomized clinical trials have demonstrated the efficacy of adjuvant 5-fluorouracil (5-FU)-based chemotherapy after surgical resection of node-positive colon cancer. Although this treatment became the standard in 1990 following a National Institutes of Health Consensus Conference, among those at least 65 years of age it is less likely to be offered to older or nonwhite patients. OBJECTIVE: To determine the association between 5-fu-based chemotherapy and survival in older patients. DESIGN: Retrospective cohort study. SETTING: Combined database of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and Medicare. PATIENTS: 4768 patients 65 years of age or older who received a diagnosis of node-positive colon cancer from 1992 to 1996, were covered by Medicare Parts A and B, and resided in the population covered by the SEER program. MEASUREMENTS: Propensity scores to control for known predictors of receiving treatment, Cox proportional hazards models to assess the association of 5-FU therapy with survival, and sensitivity analyses to estimate the possible effects of unknown confounders. RESULTS: Fifty-two percent of patients received 5-FU therapy. For this sample, the hazard ratio for death associated with 5-FU therapy was 0.66 (95% CI, 0.60 to 0.73). Confounding could have accounted for this association only if an unmeasured confounder were extremely unequally distributed between the treated and untreated groups or increased mortality by at least 50%. CONCLUSIONS: 5-Fluorouracil adjuvant therapy is significantly associated with reduced mortality in older patients, similar to the association found in randomized, controlled trials among younger patients. More frequent use of 5-FU therapy in older patients would probably reduce death from colon cancer.

@article{Sundararajan2002, abstract = {BACKGROUND: Randomized clinical trials have demonstrated the efficacy of adjuvant 5-fluorouracil (5-FU)-based chemotherapy after surgical resection of node-positive colon cancer. Although this treatment became the standard in 1990 following a National Institutes of Health Consensus Conference, among those at least 65 years of age it is less likely to be offered to older or nonwhite patients. OBJECTIVE: To determine the association between 5-fu-based chemotherapy and survival in older patients. DESIGN: Retrospective cohort study. SETTING: Combined database of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and Medicare. PATIENTS: 4768 patients 65 years of age or older who received a diagnosis of node-positive colon cancer from 1992 to 1996, were covered by Medicare Parts A and B, and resided in the population covered by the SEER program. MEASUREMENTS: Propensity scores to control for known predictors of receiving treatment, Cox proportional hazards models to assess the association of 5-FU therapy with survival, and sensitivity analyses to estimate the possible effects of unknown confounders. RESULTS: Fifty-two percent of patients received 5-FU therapy. For this sample, the hazard ratio for death associated with 5-FU therapy was 0.66 (95% CI, 0.60 to 0.73). Confounding could have accounted for this association only if an unmeasured confounder were extremely unequally distributed between the treated and untreated groups or increased mortality by at least 50%. CONCLUSIONS: 5-Fluorouracil adjuvant therapy is significantly associated with reduced mortality in older patients, similar to the association found in randomized, controlled trials among younger patients. More frequent use of 5-FU therapy in older patients would probably reduce death from colon cancer.}, added-at = {2023-02-03T11:44:35.000+0100}, author = {Sundararajan, V and Mitra, N and Jacobson, J S and Grann, V R and Heitjan, D F and Neugut, A I}, biburl = {https://www.bibsonomy.org/bibtex/2c9b1fbdf329a3be3c3583f59b112f6be/jepcastel}, interhash = {a1792ec104569d82cdfe74fe6d97877a}, intrahash = {c9b1fbdf329a3be3c3583f59b112f6be}, journal = {Annals of Internal Medicine}, keywords = {80ANDOVER;#ANTIMETABOLITES ADJUVANT;#COLONICNEOPLASMS/DRUGTHERAPY/MORTALI AGEFACTORS;AGED;AGED ANTINEOPLASTIC/THERAPEUTICUSE;CHEMOTHERAPY FACTUAL;#FLUOROURACIL/THERAPEUTICUSE;HUMANS;L NON-U.S.GOV'T;RESEARCHSUPPORT P.H.S;RETROSPECTIVESTUDIES;SENSITIVITYANDSPE U.S.GOV'T}, note = {4002<m:linebreak></m:linebreak>Propensity score}, number = 5, pages = {349-357}, timestamp = {2023-02-03T11:44:35.000+0100}, title = {Survival associated with 5-fluorouracil-based adjuvant chemotherapy among elderly patients with node-positive colon cancer}, volume = 136, year = 2002 }