This Article Full Text Full Text (PDF) CME: Take the course for this article: Referral to Medical Oncology: A Crucial Step in the Treatment of Older Pati... eLetters: Submit a response to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Luo, R. Articles by Goodwin, J. S. Search for Related Content PubMed PubMed Citation Articles by Luo, R. Articles by Goodwin, J. S.

Gastrointestinal Cancer

Referral to Medical Oncology: A Crucial Step in the Treatment of Older Patients with Stage III Colon Cancer

^a Sealy Center on Aging, ^b Department of Preventive Medicine and Community Health, and ^c Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, Texas, USA; ^d Department of Breast Medical Oncology, University of Texas M. D. Anderson Cancer Center, Galveston, Texas, USA

Key Words. Medical oncologists • Consultation • Colon cancer • SEER–Medicare • Chemotherapy

Correspondence: James S. Goodwin, M.D., The University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, Texas 77555-0460, USA. Telephone: 409-747-1987; Fax: 409-747-3585; e-mail: jsgoodwi{at}utmb.edu

Purpose. Adjuvant chemotherapy for stage III colon cancer produces a substantial survival benefit, but many older patients do not receive chemotherapy. This study examines factors associated with medical oncology consultation and evaluates the impact of such consultation on chemotherapy use.

Patients and Methods. We used the Surveillance Epidemiology and End Results–Medicare linked database and identified 7,569 patients, aged 66–99, with stage III colon cancer diagnosed from 1992–1999. Modified Poisson regression was used to assess the relative risk for seeing a medical oncologist and for receiving chemotherapy as a function of individual characteristics.

Results. 78.08% of patients saw a medical oncologist within 6 months of diagnosis. Patients who were female, white, married, had low comorbidity scores, were diagnosed in more recent years, or had four or more positive lymph nodes were more likely to see a medical oncologist. Patients seeing a medical oncologist were 10 times more likely to receive chemotherapy (odds ratio, 9.98; 95% confidence interval, 8.21–12.14), after controlling for demographic and tumor characteristics. Chemotherapy use increased over time, but was substantially lower among older, black, and unmarried patients.

Conclusions. Referral to medical oncology is one of the most important factors associated with receipt of chemotherapy among older patients with stage III colon cancer. Comorbidity decreases the likelihood of receiving chemotherapy, but its effect is the same for those who see a medical oncologist and all patients combined. Ensuring that high-risk patients are referred to medical oncology is a crucial step in quality care for patients with colon cancer.

This article has been cited by other articles:

				C. J. Bradley, C. W. Given, B. Dahman, and T. L. Fitzgerald Adjuvant Chemotherapy After Resection in Elderly Medicare and Medicaid Patients With Colon Cancer Arch Intern Med, March 10, 2008; 168(5): 521 - 529. [Abstract] [Full Text] [PDF]