Impact of Older Age on the Efficacy of Newer Adjuvant Chemotherapy Regimens in Colon Cancer, a Subgroup Analysis of a Meta-analysis: Practice Changing? Certainly Not; Hypothesis Generating? Perhaps

2009 ◽  
Vol 8 (4) ◽  
pp. 190-191 ◽  
Author(s):  
M. Sitki Copur
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Older Age

scholarly journals Lower incidence of unintentional injury with older age in children in China? A meta-analysis

2018 ◽  
Vol 4 (2) ◽  
pp. 42
Author(s):  
Hui Ting Yu ◽  
Chan Nie ◽  
Yanna Zhou ◽  
Xue Wang ◽  
Haiyan Wang ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Meta Analysis ◽  
Unintentional Injury ◽  
Total Sample ◽  
Older Age ◽  
Analysis Method ◽  
Unintentional Injuries ◽  
Cochrane Systematic Review ◽  
Spss Software ◽  
The Relationship

Objective: The aim of this study was to identify the relationship between children's age and the incidence of unintentional injuries, and giving some basic data on the guidance for the prevention of unintentional injuries in children aged 0 to 18 years in China.Methods: The literatures on the incidence of unintentional injury in children included in China from 2008 to 2018 were analyzed by meta-analysis method. The data were retrieved according to the guidance of Cochrane Systematic review. A meta-analysis was carried out on homogeneous studies, and then subgroup analysis was conducted according to age group. Publication bias was also evaluated. Stata software (version 15.0) and SPSS software (version 18.0) were used to analyze the gathered information. Results: A total of 3，303 related pieces of literature were reviewed. Of the 37 that met the inclusion criteria. The meta-analysis showed that total sample sizes were 77，023, and the pooled incidence of unintentional injury is 20%, 95%CI (17%-23%), (P< 0.001). Subgroup analysis showed the following results: the incidence are 15%, 23%, 20% and 20% for aged in “0-2”, “3-5”, “6-11”, “12-18” subgroups, respectively. However, the trend of decreased incidence of unintentional injury with older age in children was not significant.Conclusions: The pooled incidence of unintentional injuries in children is high. Based on accessible literature, the incidence between different age subgroup were not statistically significant. We should pay attention to the incidence of unintentional injuries in children of all age subgroups.

Comparative clinical efficacy of adjuvant chemotherapy regimens in randomized controlled trials (RCTs) of early-stage colon cancer: Systematic review and meta-analysis.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 498-498
Author(s):  
J. Cassidy ◽  
H. Schmoll ◽  
E. Chu ◽  
N. Hawkins ◽  
I. Tatt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Assessment Tool ◽  
Early Stage ◽  
Meta Analysis ◽  
Group Analysis ◽  
Significant Difference ◽  
Early Stage Colon Cancer

498 Background: A systematic review was conducted to identify RCTs of adjuvant chemotherapy regimens for early-stage colon cancer and a network meta-analysis performed to compare efficacy of oxaliplatin/fluoropyrimidine regimens. Methods: A systematic review identified RCTs recruiting adult patients with early-stage (adjuvant) stage II/III colon cancer. Outcome measures included hazard ratios for DFS and OS. Only publications in English were considered. Study quality was assessed using the Cochrane Collaboration “risk of bias” assessment tool. A single reviewer screened abstracts/titles using predefined selection criteria, with critical appraisal and data extraction conducted independently by two reviewers. A Bayesian network meta-analysis was used to estimate comparative efficacy of adjuvant chemotherapy across RCTs. Results: 56 articles describing 40 trials were selected, of which six reported data on regimens accepted as current standard of care (capecitabine/X-ACT, XELOX/NO16968, FOLFOX/MOSAIC, FLOX/C-07) or common comparators: bolus 5FU/LV and LV5FU2 (C-96-1, PETACC-2). Statistical assessment of heterogeneity was not possible due to the limited study network. Baseline characteristics were similar across trials with the exception of three trials recruiting only stage III patients; sub-group analysis on these trials was not possible due to lack of common comparators. There was no significant difference in DFS at a median follow-up of 3-years (or closest reported analysis) for XELOX vs. FLOX (HR=0.99, 95% CI 0.80–1.22) or FOLFOX (HR=1.00, 95% CI 0.72–1.41). There was also no significant difference in OS at a median follow-up of at least 5 years. Taken as a class, oxaliplatin-containing regimens (XELOX, FOLFOX, FLOX) improved DFS vs. non-oxaliplatin-containing regimens (HR=0.80, 95% CI 0.73–0.87). This result was confirmed for OS. Conclusions: Despite the limited number of available trials, the results of these analyses demonstrate a clear benefit of incorporating oxaliplatin into combination regimens for early-stage colon cancer. XELOX, FOLFOX and FLOX appear to be equivalent in terms of efficacy in this setting. [Table: see text]

Cochrane systematic review and meta-analysis of adjuvant chemotherapy for stage II colon cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3548-3548
Author(s):  
Brandon Matthew Meyers ◽  
Humaid Obaid Al-Shamsi ◽  
Alvaro Tell Figueredo
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Stage Ii ◽  
Cochrane Systematic Review ◽  
Free Survival ◽  
Stage Ii Colon Cancer ◽  
Disease Free

3548 Background: Colon cancer is potentially curable by surgery in the early stages of the disease. Adjuvant chemotherapy improves disease-free and overall survival in patients with stage III disease, but the magnitude of benefit in stage II colon cancer is less clear. A previous Cochrane systematic review and meta-analysis (SR/MA) found improved disease-free, but not overall survival (Figueredo et al., 2008). An updated SR/MA was performed to determine the effects of adjuvant chemotherapy on disease-free and overall survival in patients with stage II colon cancer. Methods: Relevant databases (MEDLINE, EMBASE, and Cochrane) were independently searched by all authors, using the same search strategy employed in the original study (1/1988 to 9/2012). Randomized trials containing data on stage II colon cancer patients undergoing adjuvant 5-fluorouracil (5FU) chemotherapy versus observation were included. Pooled results were expressed as hazard ratios (HR) whenever possible, or risk ratios (RR), with 95% confidence intervals (95%CI) using a random effects model. Results: Seven studies were identified, and included in the final SR/MA. Six of the 7 studies were included in the disease-free survival analysis (n=4587). Adjuvant 5FU was associated with better disease-free survival (RR 0.84 (95%CI 0.75-0.94)). All 7 studies (n=5353) were included in the overall survival analysis showing an improvement with adjuvant 5FU (HR 0.87 (95%CI 0.78-0.97)). There was no evidence of heterogeneity across the studies (I2 = 0% for all analyses). Conclusions: In stage II colon cancer, adjuvant 5FU chemotherapy statistically improves both disease-free and overall survival. Our SR/MA demonstrates, for the first time, an overall survival advantage with adjuvant chemotherapy in stage II colon cancer.

American Society of Clinical Oncology Recommendations on Adjuvant Chemotherapy for Stage II Colon Cancer

2004 ◽  
Vol 22 (16) ◽  
pp. 3408-3419 ◽  
Author(s):  
Al B. Benson ◽  
Deborah Schrag ◽  
Mark R. Somerfield ◽  
Alfred M. Cohen ◽  
Alvaro T. Figueredo ◽  
...  
Keyword(s):  
Colon Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Clinical Oncology ◽  
Meta Analysis ◽  
Indirect Evidence ◽  
Stage Ii ◽  
Prognostic Features ◽  
American Society ◽  
Stage Ii Colon Cancer

Purpose To address whether all medically fit patients with curatively resected stage II colon cancer should be offered adjuvant chemotherapy as part of routine clinical practice, to identify patients with poor prognosis characteristics, and to describe strategies for oncologists to use to discuss adjuvant chemotherapy in practice. Methods An American Society of Clinical Oncology Panel, in collaboration with the Cancer Care Ontario Practice Guideline Initiative, reviewed pertinent information from the literature through May 2003. Results A literature-based meta-analysis found no evidence of a statistically significant survival benefit of adjuvant chemotherapy for stage II patients. Recommendations The routine use of adjuvant chemotherapy for medically fit patients with stage II colon cancer is not recommended. However, there are populations of patients with stage II disease that could be considered for adjuvant therapy, including patients with inadequately sampled nodes, T4 lesions, perforation, or poorly differentiated histology. Conclusion Direct evidence from randomized controlled trials does not support the routine use of adjuvant chemotherapy for patients with stage II colon cancer. Patients and oncologists who accept the relative benefit in stage III disease as adequate indirect evidence of benefit for stage II disease are justified in considering the use of adjuvant chemotherapy, particularly for those patients with high-risk stage II disease. The ultimate clinical decision should be based on discussions with the patient about the nature of the evidence supporting treatment, the anticipated morbidity of treatment, the presence of high-risk prognostic features on individual prognosis, and patient preferences. Patients with stage II disease should be encouraged to participate in randomized trials.

scholarly journals CN2 A SYSTEMATIC REVIEW AND META-ANALYSIS OF ADJUVANT CHEMOTHERAPY FOR STAGE III COLON CANCER

2010 ◽  
Vol 13 (7) ◽  
pp. A503
Author(s):  
P Lerdkiattikorn ◽  
U Chaikledkaew ◽  
P Kingkaew ◽  
Y Teerawattananon
Keyword(s):  
Systematic Review ◽  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Meta Analysis ◽  
Stage Iii ◽  
Stage Iii Colon Cancer

Reducing time to initiation of colon cancer adjuvant chemotherapy in a large community-based hospital.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 125-125
Author(s):  
Karen Bochert ◽  
Brian Rentschler ◽  
Chris Powers ◽  
Frederick Slezak ◽  
Sameer A. Mahesh
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Meta Analysis ◽  
Relative Survival ◽  
Office Visit ◽  
Standard Of Care ◽  
Pathology Report ◽  
Port Placement ◽  
Before And After ◽  
Stage Ii Colon Cancer

125 Background: Chemotherapy is standard of care after definitive surgery for stage III and certain subsets of stage II colon cancer (CC). A recent meta-analysis showed that for every 4 week delay in administering adjuvant chemotherapy relative survival decreases by 15%. At our institution, 24% of patients undergoing colon cancer surgery in 2010 subsequently received chemotherapy. On average, this process took 41 days from date of discharge to first chemotherapy (range 12-166 days). We sought to decrease this time to an average of 28 days. Methods: Previously, starting adjuvant chemotherapy was a step-wise process starting from the surgeon’s post operative visit to the medical oncologist’s office visit followed by port placement and finally, the commencement of chemotherapy. We instituted a program of concurrent scheduling of appointments by the colorectal cancer navigator (CRCN) upon availability of the pathology report. Primary end-point was time to start of chemotherapy from day of discharge (TTCD). Results: Twenty-three patients were eligible since inception of the program in September 2011. Of these, 5 declined entry and 2 were under the care of non-participating physicians, hence excluded from analysis. TTCD before and after implementation of the program are shown in the table. Two patients required financial assistance for capecitabine (C) that delayed TTCD to > 4 weeks. Results are shown after excluding those patients as well. Conclusions: Utilizing the CRCN to coordinate appointments for patients who required adjuvant chemotherapy significantly decreased the TTCD which might translate into better CC outcomes. [Table: see text]

scholarly journals Patients’ preferences for 3 months versus 6 months of adjuvant chemotherapy for colon cancer

2020 ◽  
Author(s):  
Prunella Blinman ◽  
Andrew Martin ◽  
Michael Jefford ◽  
David Goldstein ◽  
David Boadle ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
New Zealand ◽  
Treatment Group ◽  
Adjuvant Chemotherapy ◽  
Meta Analysis ◽  
Survival Rates ◽  
Phase 3 ◽  
Validated Questionnaire ◽  
Baseline Characteristics

Abstract Background SCOT was an international, randomised phase 3 trial of 3 months versus 6 months of adjuvant chemotherapy with oxaliplatin and a fluoropyrimidine in patients with colorectal cancer. We sought patients’ preferences for 3 months versus 6 months of adjuvant chemotherapy in the SCOT trial. Methods SCOT participants from Australia and New Zealand completed a validated questionnaire (at 3 and 18 months) to elicit the minimum survival benefits judged necessary to make an extra 3 months of adjuvant chemotherapy worthwhile, based on their experience. Standardised hypothetical scenarios used the following baseline survivals (with 3 months of chemotherapy): life expectancies (LE) of 5 years (5Y) and 15 years (15Y); and, 5-year survival rates (5YS) of 65% and 85%. Results Of the 160 participants, 82 were assigned 3 months adjuvant chemotherapy, and 78 assigned 6 months. Adjuvant chemotherapy was FOLFOX in 121 (75.6%), XELOX in 39 (24.4%). Preferences varied substantially and did not differ according to treatment group. The median survival benefits judged necessary to make the extra 3 months of chemotherapy worthwhile were an extra: 3 years beyond a LE of 5Y; 3 years beyond a LE of 15Y; 15% beyond a 5YS of 65%; and 5% beyond a 5YS of 85%. Preferences were similar at 3 months and 18 months. Preferences were not predicted by participants’ baseline characteristics. Conclusion Preferences varied substantially, and the benefits many required to warrant an extra 3 months of adjuvant chemotherapy were larger than the benefits of an extra 3 months of chemotherapy calculated in the IDEA meta-analysis.

scholarly journals The association of comorbidities with administration of adjuvant chemotherapy in stage III colon cancer patients: a systematic review and meta-analysis

2021 ◽  
Vol 13 ◽  
pp. 175883592098652
Author(s):  
Daniel Boakye ◽  
Rajini Nagrini ◽  
Wolfgang Ahrens ◽  
Ulrike Haug ◽  
Kathrin Günther
Keyword(s):  
Systematic Review ◽  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Stage Iii ◽  
Comorbid Condition ◽  
Random Effects Models ◽  
Stage Iii Colon Cancer ◽  
Chemotherapy Administration

Background: Chemotherapy is an established treatment for stage III colon cancer cases. Older age is known to be associated with less chemotherapy use in these patients, but there might be other relevant factors besides age that influence treatment administration. We summarized evidence on associations between comorbidity and adjuvant chemotherapy administration in stage III colon cancer patients in a systematic review and meta-analysis. Methods: We searched the PubMed and Web of Science databases up to 2 June 2020 for studies on comorbidities and chemotherapy use in patients with stage III colon cancer. Summary odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using random-effects models. Subgroup analyses according to year of colon cancer diagnosis, timing of comorbidity assessment, and geographical region were also conducted. Results: Thirty-three studies were included in this review, including 219,406 stage III colon cancer patients overall. Chemotherapy administration was 60.9% (95% CI: 56.9% to 64.9%), increasing from 57.1% before 2001 to 66.3% after 2010. There were inverse associations between comorbidities and chemotherapy administration. Compared with patients with Charlson comorbidity score 0, those with scores 1 (OR = 0.79, 95% CI = 0.72–0.87) and 2+ (OR = 0.49, 95% CI = 0.42–0.56) received chemotherapy less often. Among comorbidities, the strongest predictors of chemotherapy non-use were dementia (OR = 0.37, 95% CI = 0.33–0.54), followed by heart failure (OR = 0.44, 95% CI = 0.28–0.70) and stroke (OR = 0.56, 95% CI = 0.38–0.81). Conclusions: Merely 60% of stage III colon cancer patients receive chemotherapy. Comorbidities are strong predictors of chemotherapy non-use, but the association differs by comorbid condition and is strongest with dementia. Given the survival disadvantage of colon cancer patients with comorbidities, further evidence on the risk–benefit ratio of chemotherapy according to the type and severity of comorbidity and on the extent to which the survival disadvantage of comorbidity is explained by less use or lower tolerability of chemotherapy is needed to foster personalized medical care in these patients.

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