Who gets adjuvant treatment for stage II and III rectal cancer? Insight from surveillance, epidemiology, and end results-medicare

Purpose: To examine the relationship between patient characteristics and th e use of adjuvant pelvic radiation with and without chemotherapy among pati ents aged 65 years and older with stage If and III rectal cancer. Patients and Methods: A retrospective cohort study using the Surveillance, Epidemiology, and End Results-Medicare linked database identified 1,411 pat ients aged 65 and older with resected stage If and III rectal cancers diagn osed between 1992 and 1996. From claims submitted to Medicare, we measured the use of pelvic radiation therapy with or without chemotherapy and pre- o r postoperatively. Results: Fifty-seven percent of patients received radiation, 42% received c hemotherapy and radiation, and 7% had treatment delivered preoperatively. A ge was the strongest determinant of treatment: 73% of patients aged 65 to 6 9, 66% aged 70 to 75, 52% aged 75 to 79, 39% aged 80 to 84, and 21% aged 85 to 89 received radiation. The age trend remained strong after adjusting fo r other factors that predict receipt of treatment and after exclusion of pa tients with any evident comorbidity (P < .001). Patients were more likely t o receive radiation treatment if they had an abdominal perineal resection, stage III disease, or a T4 tumor. Conclusion: Because pelvic recurrences are a substantial cause of morbidity , further efforts are needed to ensure that elderly patients have the oppor tunity to make informed decisions regarding adjuvant treatment. (C) 2001 by American Society of Clinical Oncology.