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Cited by 146Colorectal Cancer Treatments and StudiesColorectal Cancer Surgical TreatmentsGenetic factors in colorectal cancer

Outcomes and toxicity in African-American and Caucasian patients in a randomized adjuvant chemotherapy trial for colon cancer

McCollum, A. D.·2002·CancerSpectrum Knowledge Environment
DOI 10.1093/jnci/94.15.1160
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Abstract

BACKGROUND: Previous studies have demonstrated that African-Americans with colon cancer have worse overall and stage-specific survival rates than Caucasians. Such differences could reflect variation in access to health care, in tumor biology, or in treatment efficacy. Little is known about potential differences in chemotherapy-related toxicities between African-Americans and Caucasians. In this study, we examined survival and toxic effects among African-American and Caucasian patients enrolled in a large, randomized phase III trial of adjuvant chemotherapy for resected colon cancer. METHODS: We analyzed data on 3380 patients (344 African-Americans and 3036 Caucasians) enrolled in a randomized trial of adjuvant 5-fluorouracil-based chemotherapy in patients with stage II (high risk) and stage III colon cancer to evaluate differences in outcomes and toxicity. We compared disease-free survival (DFS) and overall survival (OS) between African-Americans and Caucasians by the Kaplan-Meier method, computed Cox proportional hazards by multivariable analysis, and compared treatment-related toxicity rates by Fisher's exact test. All statistical tests were two-sided. RESULTS: We found no differences in DFS or OS between African-American and Caucasian patients. Five-year DFS was 57% (95% confidence interval [CI] = 52% to 62%) for African-Americans and 58% (95% CI = 56% to 60%) for Caucasians (P =.15), and 5-year OS was 65% (95% CI = 60% to 70%) for African-Americans and 66% (95% CI = 64% to 68%) for Caucasians (P =.38). On multivariable analysis, no statistically significant difference in disease recurrence or death was detected between the racial/ethnic groups (hazard ratios for African-Americans versus Caucasians: disease recurrence = 1.1, 95% CI = 0.9 to 1.3; death = 1.1, 95% CI = 0.9 to 1.3). Treatment-related toxicity differed between the African-American and Caucasian patients, with African-Americans experiencing statistically significantly lower rates of diarrhea (P<.001), nausea (P<.001), vomiting (P =.01), stomatitis (P<.001), and overall toxicity (P =.005). CONCLUSIONS: In this study of patients with similar access to health care resources and treatment with adjuvant chemotherapy, we found similar 5-year DFS and OS in African-Americans and Caucasians with stage II and III colon cancer. The two groups derived similar benefits from adjuvant chemotherapy. Moreover, African-Americans appeared to experience less treatment-related toxicity.

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Authors
McCollum, A. D.
Affiliations
University of Oxford (GB)
Corresponding author
McCollum, A. D.
Venue
CancerSpectrum Knowledge Environment
Publisher
Oxford University Press (OUP)
Published
2002-08-07
Volume
94
Issue
15
Pages
1160-1167
ISSN
  • 0027-8874 (ISSN-L)
  • 1460-2105
DOI
10.1093/jnci/94.15.1160
OpenAlex
W2151824850
Cited by
146
References
27
Citations by year
2025: 2 · 2024: 3 · 2023: 6 · 2022: 3 · 2021: 8 · 2020: 7 · 2019: 4 · 2018: 4 · 2017: 1 · 2016: 4 · 2015: 7 · 2014: 5 · 2013: 13 · 2012: 3
FWCI
3.25
Type
journal article
Language
en
Open access
closed
Locations
  • JNCI Journal of the National Cancer Institute (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (2u10ca058415-06)
  • National Cancer Institute (CA-23318, CA-15488, U10CA032291, CA 58415, CA 32291, U10CA023318, U10CA021115, U10CA015488, CA 21115)
Topics
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Treatments and Studies
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Genetic factors in colorectal cancer
Keywords
colon cancer, African American patients, racial disparities, adjuvant chemotherapy, 5-fluorouracil, treatment toxicity, disease-free survival, overall survival, diarrhea, stomatitis, nausea and vomiting, resected colon cancer, ethnic differences in cancer outcomes, health care access, treatment efficacy
MeSH terms
Antimetabolites, Antineoplastic, Black or African American, Colonic Neoplasms, Fluorouracil, Humans, Treatment Outcome, Chemotherapy, Adjuvant, Black People, White People

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