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Relative effectiveness and safety of chemotherapy in elderly and nonelderly patients with stage III colon cancer: a systematic review.

Publication ,  Journal Article
Hung, A; Mullins, CD
Published in: Oncologist
2013

BACKGROUND: Chemotherapy effectiveness in clinical practice may differ from the efficacy demonstrated in clinical trials, particularly among populations underrepresented in clinical trials, such as elderly patients with cancer. This review aims to examine the relative effectiveness of chemotherapy for stage III colon cancer in elderly versus nonelderly patients. METHODS: A systematic literature review was conducted using the Agency for Healthcare Research and Quality approach. Literature searches were performed in Medline and Evidence-Based Medicine Reviews databases. Chemotherapy regimens approved for stage III colon cancer were reviewed. Four effectiveness and 15 safety outcomes were extracted. RESULTS: From 708 identified articles, 25 articles provided data on the relative effectiveness and safety of chemotherapy among elderly versus nonelderly patients. Four of 14 studies showed lower overall survival treatment effects, whereas one of five and one of four studies indicated more favorable treatment effects for time to progression and overall response rate. Grade 3 or 4 adverse events were higher among elderly patients for cardiac disorder (2/5 studies), leukopenia (1/5), neutropenia (4/16), thrombocytopenia (2/13), febrile neutropenia (1/4), infection (2/10), dehydration (2/6), diarrhea (6/20), and fatigue (6/13). Grade 3 or 4 adverse events were lower for neutropenia (2/16 studies), nausea/vomiting (1/16), and neuropathy (1/9). CONCLUSION: The majority of the evidence suggests that chemotherapy has similar relative effectiveness and safety for patients >65 years of age versus younger patients with stage III colon cancer. When differences are reported, treatment effects are more often worse among the elderly. This review suggests that without other reasons for withholding treatment, elderly patients should receive chemotherapy as often as nonelderly patients.

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Published In

Oncologist

DOI

EISSN

1549-490X

Publication Date

2013

Volume

18

Issue

1

Start / End Page

54 / 63

Location

England

Related Subject Headings

  • Survival Analysis
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Humans
  • Female
  • Drug-Related Side Effects and Adverse Reactions
  • Cost-Benefit Analysis
  • Colonic Neoplasms
 

Citation

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Hung, A., & Mullins, C. D. (2013). Relative effectiveness and safety of chemotherapy in elderly and nonelderly patients with stage III colon cancer: a systematic review. Oncologist, 18(1), 54–63. https://doi.org/10.1634/theoncologist.2012-0050
Hung, Anna, and C Daniel Mullins. “Relative effectiveness and safety of chemotherapy in elderly and nonelderly patients with stage III colon cancer: a systematic review.Oncologist 18, no. 1 (2013): 54–63. https://doi.org/10.1634/theoncologist.2012-0050.
Hung, Anna, and C. Daniel Mullins. “Relative effectiveness and safety of chemotherapy in elderly and nonelderly patients with stage III colon cancer: a systematic review.Oncologist, vol. 18, no. 1, 2013, pp. 54–63. Pubmed, doi:10.1634/theoncologist.2012-0050.

Published In

Oncologist

DOI

EISSN

1549-490X

Publication Date

2013

Volume

18

Issue

1

Start / End Page

54 / 63

Location

England

Related Subject Headings

  • Survival Analysis
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Humans
  • Female
  • Drug-Related Side Effects and Adverse Reactions
  • Cost-Benefit Analysis
  • Colonic Neoplasms