High Costs for Limited Survival Gain in Older Colorectal Cancer Patients
Significant side effects and the high cost of treatment only extend survival by a month in
Despite the high cost of treatments and side effects, elderly patients with metastatic colorectal cancer are seeing only a 1-month gain in median survival, according to a study published in the journal Medical Care.
Scientists from the University of Colorado Cancer Center studied the data of 20,000 Medicare patients between 2000 and 2009 with metastatic colon or rectal cancer.
The study looked at the percentage of patients treated with chemotherapy or the targeted agent bevacizumab, which has shown survival benefits for younger patients with early stage cancer.
The results of the study showed that the overall survival rate was 8 months for patients 65 to 74-years-old, but had little to no benefits for those who are 75-years and older with metastatic cancer.
"Doctors and patients come to a point where none of the standard therapies have worked and so they're willing to take a risk because there are no other treatment options available,” said first study author Cathy J. Bradley, PhD. “They decide to give newly approved therapies a try despite there being no solid evidence for their use in these older low life-expectancy patients.”
Over a 10-year period, the study found the rate of metastatic colorectal cancer patients older than age 75 administered 3 or more treatments spiked from 2% to 53%.
The study also showed that there was an increase in treatment costs by 32% in colon cancer and 20% in rectal cancer for an estimated $2.2 billion. In 2009, patients paid around $16,000 in out-of-pocket costs compared with $11,000 in 2000.
Those who did not undergo chemotherapy paid less than $5000 on average in the year after diagnosis. During the study, oxaliplatin cost $11,593 while the combination of 5-FU and leucovorin cost $1028.
Along with the cost incurred with chemotherapy, additional spending is required for supportive medications that help relieve side effects, along with hospital inpatient and outpatient costs.
"No one wants to give up,” Bradley said. “It's hard for anyone to say they've had enough. However, in these situations palliative care may be a good option. Taken together, multiagent regimens may not be of high value in terms of costs and survival for older mCRC patients."