Stage III colon cancers: why adjuvant chemotherapy is not offered to elderly patients

Arch Surg. 2000 Feb;135(2):182-5. doi: 10.1001/archsurg.135.2.182.


Hypothesis: Adjuvant chemotherapy is not offered to elderly patients with stage III colon cancer.

Design: A retrospective review of hospital and office records.

Setting: A suburban community hospital.

Patients: The medical records of 69 patients with stage III colon cancer were reviewed. All identified from the Tumor Registry at Jersey Shore Medical Center, Neptune, NJ, were included in this study.

Results: Thirty-five patients (51%) did not receive adjuvant chemotherapy. After adjusting for age, women were 5.8 times less likely to receive chemotherapy (P = .002). Patients not receiving chemotherapy were significantly older (78.7 vs 70.4 years; P = .003) than those who received adjuvant chemotherapy. There was no relation found between the year of diagnosis and the administration of chemotherapy. There were 4 major reasons for not receiving chemotherapy: (1) not offered (n = 12, 34%), (2) refused (n = 11, 31%), (3) too old (n = 7, 20%), and (4) significant concomitant disease (n = 5, 14%).

Conclusions: A large group of elderly patients who had been surgically treated for colon cancer and who were eligible for adjuvant chemotherapy either were not referred for treatment or refused treatment. This suggests a bias on the part of surgeons, primary care physicians, and patients against the use of chemotherapy in elderly patients.

MeSH terms

  • Age Distribution
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use*
  • Chemotherapy, Adjuvant / statistics & numerical data
  • Colonic Neoplasms / drug therapy*
  • Colonic Neoplasms / pathology
  • Colonic Neoplasms / surgery
  • Colorectal Neoplasms / drug therapy*
  • Colorectal Neoplasms / pathology
  • Colorectal Neoplasms / surgery
  • Female
  • Humans
  • Male
  • Neoplasm Staging
  • Refusal to Treat
  • Retrospective Studies
  • Sex Factors
  • Treatment Refusal


  • Antineoplastic Agents