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【medical-news】结肠癌不应过早停止用药
While colon cancer patients must undergo surgery for a cure, to reduce the risk that the disease will return, chemotherapy is often given.
Dr. Alfred I. Neugut and colleagues, at Columbia University in New York, note that 6 months of fluorouracil-based chemotherapy is the standard of care for treating colon cancer that has invaded nearby lymph nodes.
However, previous studies suggest that about half of the patients 65 years of age or older do not receive chemotherapy. The researchers primary goal was to analyze outcomes according to length of treatment with chemotherapy.
The study, which is reported in the Journal of Clinical Oncology, involved 3,733 patients in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer registry whose records were linked with their Medicare claims filed between 1995 and 1999.
In this group, 613 patients received no more than 4 months of chemotherapy. Their death rates were similar to those of 2011 patients who received no chemotherapy.
However, chemotherapy for 5 to 7 months reduced the risk of death from colon cancer by about 50 percent.
Neugut and his associates point out that earlier cessation of treatment did not necessarily cause the decreased survival. They suggest that patients may be at high risk because of the same factors that lead to their discontinuing treatment.
Meanwhile, west coast researchers identified physical frailty, treatment complications, and lack of social and psychological support as factors associated with an incomplete course of chemotherapy, according to their paper in the Journal of the National Cancer Institute.
Dr. Sharon B. Dobie, from the University of Washington in Seattle, and associates also evaluated data from the SEER registry from 1992 to 1996 linked to Medicare claims for patients age 66 or older with surgically removed colon cancer.
Included were 2,162 patients who received no chemotherapy, 569 who received a less than complete course, and 1,980 who received a complete course, defined as 5 months or more.
The strongest predictors of an incomplete course were rehospitalization during the time chemotherapy was being given, age younger than 75 years, female gender and widowed status.
Dobie and her associates recommend interventions to improve social and physical support during treatment, as well as studies of patient preferences to more fully understand factors involved in chemotherapy completion.
SOURCE: Journal of Clinical Oncology, May 2006; Journal of the National Cancer Institute, May 3, 2006. 2006年5月10日“路透社健康”（Reuters Health）纽约电——新的研究建议晚期结肠癌切除的老年病人应至少完成5个月的以氟尿嘧啶为基础的化疗。任何较早停用这些化疗药会增加癌症复发风险，其结果与完全不进行化疗的患者一样差。
虽然结肠癌患者为治愈必须进行手术，病人还常常接受化疗以减少癌症复发的风险。
纽约哥伦比亚大学的Alfred I. Neugut 医师和同事强调，对与已侵入附近淋巴结的结肠癌的辅助治疗标准是6个月的以氟尿嘧啶为基础的化疗。
然而，早前的研究表明65岁以上患者大约一半没有接受化疗。研究人员的主要目的是依照化疗治疗长度分析结果。
在《临床肿瘤学杂志》上发表的研究分析了美国国家癌症研究所的监测、流行病及最终结果（SEER）癌症登记的3,733位病人，这些病人的记录与在1995年到1999年间他们的医疗保险请求档案相联系。
在这组病人中，613位接受4个月以下的化疗。他们的死亡率与那些不接受化疗的2011位病人相似。
可是，患者进行5到7个月的化疗会减少死于结肠癌的风险约大约50％。
Neugut医师和同事指出较早停止治疗不会必然地导致生存率减小。他们提示，因为导致病人中断治疗的同样因素存在，病人也许仍面临很高的复发风险。
同时，根据《美国国家癌症研究所杂志》上的另一篇文章，西海岸的研究人员确认身体状况不佳、治疗并发症、缺乏社会和心里支持等作为与化疗未完原因的相关因素，。
西雅图华盛顿大学的Sharon B. Dobie医师和同事也评估了年龄在66岁以上并行结肠癌手术切除病人资料，这些资料来自1992 年到1996年间与病人医疗保险请求相联系的SEER癌症登记。资料包括2162位没有进行化疗病人，569位接受少于完整疗程化疗的病人，还有1980位接受完整疗程化疗的病人，规定完整疗程化疗长度为至少5个月时间。
一个不能完成的疗程的最强预测因素有给予化疗期间再住院、年龄低于75岁，丧偶女性。
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作者:admin@医学,生命科学 2011-02-14 18:18
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