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On the basis of accumulated evidence from clinical trials, a 1990 NIH Consensus Development Conference recommended that patients with stage III colon cancer be given adjuvant chemotherapy. The 1990 NIH Consensus Conference also recommended combined adjuvant chemotherapy and high-dose external-beam radiotherapy for stage II and III rectal cancer. Radiation does not appear to affect disease-specific or overall survival for rectal cancer, although it does decrease local recurrence.
Percent of individuals, aged 20 years and older, diagnosed with stage III colon cancer who received chemotherapy or diagnosed with stage II or stage III rectal cancer who received chemotherapy with or without radiotherapy.
In 2005, 60 percent of stage III colon and stage II and III rectal patients aged 65 years and older received adjuvant chemotherapy, while more than 85 percent of patients aged 20 to 64 received chemotherapy. A colorectal NCI patterns of care study is currently being conducted for diagnosis year 2010.
There are no Healthy People targets for cancer treatment, including colorectal cancer treatment.
Studies have found that older colorectal patients are less likely to receive adjuvant chemotherapy treatment, even after adjustment for the higher rate of pre-existing co-morbid conditions among older patients. Even elderly patients with no or very few co-morbid conditions, such as diabetes, kidney disease, or heart disease, were less likely to receive treatment. Earlier studies indicated that black patients were less likely to receive treatment than white patients; however, this disparity was not found in the 2000 NCI Patterns of Care/Quality of Care study. Older patients continue to receive adjuvant chemotherapy less often than younger patients.
Chemotherapy for colorectal cancer is a rapidly evolving field. Emerging treatments include chemotherapy regimens that incorporate irinotecan and/or oxaliplatin agents that interfere with DNA synthesis during cancer cell division and, more recently, anti-angiogenesis agents. These newer drugs result in better outcomes for many colorectal cancer patients, but they also are much more expensive than earlier treatments.