Colorectal Cancer Part 6: Chemotherapy for the Elderly - Is It Worth It?

According to the editorial in the New England Journal of Medicine (advanced age - and not a hindrance to cancer treatment. Vol: 345: 1128-1129. October 2001), more than half of all new cancers in the U.S. in patients 65 years of age or older . Also, around two thirds to three quarters of the cases of colorectal cancer in these older age groups and three quarters of them die of the disease. In another report, in the same journal (Vol: 345: 1091-1097) entitled: "A publicpooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients, "Dr. Daniel Sargent and his colleagues analyzed data from 3351 patients and compared the performance of patients in four different age groups. They concluded that:

1. Selected elderly patients with colorectal cancer may have the same performance "of patients with chemotherapy as their younger colleagues.

2. The five-year survival rate was 71% for those receivingChemotherapy and 64% for those who do not receive chemotherapy.

3. The toxic effects of therapy were nausea or vomiting, diarrhea, stomatitis and leukopenia (ie) reduction of white blood cells. The toxic effects in those aged over 75 years, not increased as compared to other age groups.

Question: The difference in performance between chemotherapy (5-FU + leucovorin or 5-FU
+ Levamisole) and no chemotherapy was 7%. This benefit of increased survival comes with toxic side effectsEffects. While younger patients may be able to tolerate the side effects, I wonder if the elderly want to go through such "suffering." In order to provide oncologists and researchers, the results were "statistically significant", but from the perspective of the patient, I'm wondering if it worth it?

Theodore, JI & Lamont, EB (in: The efficacy of adjuvant fluorouracil in clinical practice: A population-based cohort study of elderly patients with stage III colon cancer.J. of Clinical Oncology. October 2002. Vol: wrote 20: 3992-3998):

"In five years, were treated, 52.7% of the elderly, patients with stage III colon adjuvant 5-FU alive compared to only 40.7% of untreated patients."

Questions: If you are old and had an operation on your stage 3 colon, but decided not to go for chemotherapy - you would soon die out? The answer is no. The data of these studies show that you may still be alive after five years if youundergone chemotherapy. Think about this carefully: For every 100 elderly patients who are undergoing chemotherapy, only 12 of them benefit from the treatment. This means that 88 elderly patients to tolerate the side effects of chemotherapy, and they do not benefit from treatment.

Yang, TS and colleagues (in Phase II clinical trial of a weekly 8-hour 5-fluorouracil and folinic acid infusion in patients with advanced colorectal cancer: dose adjusted according to theirToxicity. Japanese Journal of Clinical Oncology. 2,001th Vol: 31: 610-615) studied 26 patients with inoperable metastastatic or local recurrence of colorectal carcinoma. The patients were treated with 5-FU + leucovorin. The results of their findings were:

1. The study began in June 1998, but until December 2000, and a half years later, only 3 patients alive, that was 23 of 26 patients and 88% were dead. They survived for 1.5 to 28.3 months (median survival = 12.1Months).

2. The overall survival rate was 53.8% at 1 year and 11.5% after 2 years.

3. The most common side effects were observed were nausea, vomiting, diarrhea and mucositis.

4. Hand-foot syndrome occurred in 11.5% of patients.

5. Fatigue or weakness occurred in 57.7% of patients.

6. The study was terminated because the expected return rate was not achieved as expected.

Questions: Are the results of this study in Taipei, Taiwan, not thepainful experiences of most cancer patients who have undergone chemotherapy? Are we to believe that chemotherapy for colorectal cancer is good if 88% were dead 1.5 years after chemotherapy?

I often tell this to cancer patients: How much longer to live, is not important. How do you live within his lifetime, is the core of the problem. What is the point of being alive if you spend most of your time into and out of the hospital, or enduring the pageEffects of treatment?

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