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@ARTICLE{Walter:144745,
      author       = {V. Walter$^*$ and D. Boakye$^*$ and J. Weberpals$^*$ and L.
                      Jansen$^*$ and W. E. Haefeli and U. M. Martens and P. Knebel
                      and J. Chang-Claude$^*$ and M. Hoffmeister$^*$ and H.
                      Brenner$^*$},
      title        = {{D}ecreasing {U}se of {C}hemotherapy in {O}lder {P}atients
                      {W}ith {S}tage {III} {C}olon {C}ancer {I}rrespective of
                      {C}omorbidities.},
      journal      = {Journal of the National Comprehensive Cancer Network},
      volume       = {17},
      number       = {9},
      issn         = {1540-1413},
      address      = {Cold Spring Harbor, NY},
      publisher    = {Harborside Press},
      reportid     = {DKFZ-2019-02177},
      pages        = {1089 - 1099},
      year         = {2019},
      abstract     = {Chemotherapy underuse in elderly patients (aged ≥75
                      years) with colon cancer has been reported in previous
                      studies. However, these studies were mostly registry-based
                      and limited in their potential to consider underlying
                      reasons of such undertreatment. This study aimed to evaluate
                      patient and hospital determinants of chemotherapeutic
                      treatment in patients with stage III colon cancer, with a
                      particular focus on age and underlying reasons for
                      nontreatment of elderly patients.A total of 629 patients
                      with stage III colon cancer who were diagnosed in 2003
                      through 2012 and recruited into a population-based study in
                      the Rhine-Neckar region of Germany were included.
                      Information on sociodemographic and lifestyle factors,
                      comorbidities, and treatment was collected from patient
                      interviews and physicians. Patient (with an emphasis on age)
                      and hospital factors were evaluated for their associations
                      with administration of adjuvant chemotherapy overall and of
                      oxaliplatin specifically using multivariable logistic
                      regression.Administration of chemotherapy decreased from
                      $94\%$ in patients aged 30 to 64 years to $51\%$ in those
                      aged ≥75 years. A very strong decline in chemotherapy use
                      with age persisted even after comprehensive adjustment for
                      multiple patient factors-including comorbidities-and
                      hospital factors and was also seen among patients without
                      any major comorbidities. Between 2005 and 2008, and 2009 and
                      2012, chemotherapy administration in patients aged ≥75
                      years decreased from $60\%$ to $41\%.$ Among chemotherapy
                      recipients, old age was also strongly associated with higher
                      odds of nonadministration of oxaliplatin. The 2 most
                      commonly reported reasons for chemotherapy nonreceipt among
                      the study population were patient refusal $(30\%)$ and old
                      age $(24\%).Age$ was the strongest predictor of chemotherapy
                      underuse, irrespective of comorbidities and even in patients
                      without comorbidities. Such underuse due just to older age
                      in otherwise healthy patients deserves increased attention
                      in clinical practice to ensure that elderly patients also
                      get the best possible care. Patients' refusal as the most
                      frequent reason for chemotherapy nonreceipt also warrants
                      further investigation to exclude misinformation as
                      underlying cause.},
      cin          = {C070 / C120 / C020 / L101},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331 / I:(DE-He78)C120-20160331 /
                      I:(DE-He78)C020-20160331 / I:(DE-He78)L101-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:31487678},
      doi          = {10.6004/jnccn.2019.7287},
      url          = {https://inrepo02.dkfz.de/record/144745},
}