Abstract
BackgroundNumerous clinical trials have demonstrated that elderly patients with colorectal cancer (CRC) can benefit from chemotherapy, yet compliance in real-world practice is low. The purpose of this study is to investigate the efficacy, compliance and reasons for refusal of postoperative chemotherapy for elderly patients with CRC and to provide corresponding strategies.Patients and methodsThe clinico-pathological and biochemical data of the chemotherapy group and chemo-refusing group were compared among 386 elderly patients (>70 years old) with CRC who underwent surgery. 226 patients received chemotherapy and 160 patients refused. Follow-up of the subjective reasons for refusal was investigated using the elderly caner patients' chemo-refusal reason questionnaire (ECPCRRQ) prepared by the authors and a group of psychologists. The questionnaire is administrated by telephone. A predictive model for 5-year disease-free survival (DFS) and 5-year overall survival (OS) was constructed by using Kaplan-Meier analysis, logistic and Cox regression.ResultsAmong stage III patients, receiving chemotherapy was associated with a significantly higher OS (68%) compared to those who refused (OS50%) (HR: 2.05, 95%CI: 1.12–3.77, P = 0.02). The Chemo-refusal group had more female and elderly patients, significantly higher rate of severe complications, and lower body mass index (BMI). Follow-up phone questionnaire analysis showed the doctors’ uncertainty of chemotherapy benefit, economic difficulties, uncomfortable feeling, superstition of Traditional Chinese Medicine, concealing information and lack of social support were the main factors for elderly CRC patients to decline chemotherapy.ConclusionThe receipt of post-operative chemotherapy in elderly patients with resected stage III CRC was associated with a more favorable survival. The low compliance rate (160/386) of postoperative chemotherapy was influenced by various subjective and objective factors.
Highlights
Since 1990, chemotherapy has been the standard postoperative treatment for patients with stage IIB, III, IV colorectal cancer (CRC) [1,2,3], but the efficacy and toxicity of chemotherapy in patients older than 70 years of age has been a matter of controversy
Follow-up phone questionnaire analysis showed the doctors’ uncertainty of chemotherapy benefit, economic difficulties, uncomfortable feeling, superstition of Traditional Chinese Medicine, concealing information and lack of social support were the main factors for elderly CRC patients to decline chemotherapy
These elderly patients were all eligible for clinical trial enrollment and were known to have a more favorable performance status and fewer comorbidities compared with the general elderly population [9,10,11,12,13,14]
Summary
Since 1990, chemotherapy has been the standard postoperative treatment for patients with stage IIB, III, IV CRC [1,2,3], but the efficacy and toxicity of chemotherapy in patients older than 70 years of age has been a matter of controversy. Pooled analyses of the safety and efficacy of chemotherapy in the elderly have shown comparable toxicity rates and similar survival benefits compared with younger patients. These elderly patients were all eligible for clinical trial enrollment and were known to have a more favorable performance status and fewer comorbidities compared with the general elderly population [9,10,11,12,13,14]. Numerous clinical trials have demonstrated that elderly patients with colorectal cancer (CRC) can benefit from chemotherapy, yet compliance in real-world practice is low. The purpose of this study is to investigate the efficacy, compliance and reasons for refusal of postoperative chemotherapy for elderly patients with CRC and to provide corresponding strategies
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