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Background: The objective of this study was to determine how patient preferences guide the course of palliative chemotherapy for advanced colorectal cancer., Methods: Eligible patients with metastatic colorectal cancer (mCRC) were enrolled nationwide in a prospective, population-based cohort study. Data were obtained through medical record abstraction and patient surveys. Logistic regression analysis was used to evaluate patient characteristics associated with visiting medical oncology and receiving chemotherapy and patient characteristics, beliefs, and preferences associated with receiving >1 line of chemotherapy and receiving combination chemotherapy., Results: Among 702 patients with mCRC, 91% consulted a medical oncologist; and among those, 82% received chemotherapy. Patients ages 65 to 75 years and aged ≥75 years were less likely to visit an oncologist, as were patients who were too sick to complete their own survey. In adjusted analyses, patients aged ≥75 years who had moderate or severe comorbidity were less likely to receive chemotherapy, as were patients who were too sick to complete their own survey. Patients received chemotherapy even if they believed that chemotherapy would not extend their life (90%) or that chemotherapy would not likely help with cancer-related problems (89%), or patients preferred treatment focusing on comfort even if it meant not living as long (90%). Older patients were less likely to receive combination first-line therapy. Patient preferences and beliefs were not associated with receipt of >1 line of chemotherapy or combination chemotherapy., Conclusions: The majority of patients received chemotherapy even if they expressed negative or marginal preferences or beliefs regarding chemotherapy. Patient preferences and beliefs were not associated with the intensity or number of chemotherapy regimens., (Copyright © 2012 American Cancer Society.)

Purpose: Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed drugs for the treatment of osteoarthritis (OA). While there are documented racial differences in the use of opioid analgesics, little is known about racial differences in the use of NSAIDs., Methods: This was a retrospective cohort study among a national sample of 6038 veterans with OA. Patients were new NSAID users, followed for approximately 6 months. Primary outcomes included: type of NSAID prescribed (COX-2 selective or preferentially COX-2 selective NSAIDs vs other NSAIDs), days' supply of initial prescription and time to discontinuation of the index NSAID., Results: In an analysis adjusted for demographic and gastrointestinal (GI) bleeding risk factors (age, sex, geographic region, history of GI bleeding, comorbid illnesses, use of anti-coagulants and glucocorticoids), Hispanics were less likely than whites to be prescribed an NSAID with some degree of COX-2 selectivity (odds ratio (OR): 0.47, p < 0.01). The days' supply of the initial prescription was lower for both blacks and Hispanics compared to whites (mean: 38, 31 and 43 days respectively, p < 0.01). In an analysis adjusted for demographics, GI bleeding risk factors and type of NSAID prescribed, blacks discontinued use of the index NSAID earlier than whites (hazard ratio = 1.19, p < 0.001) and there was a similar trend for Hispanics., Conclusion: Minorities with OA were prescribed NSAIDs with less COX-2 selectivity and lower days' supply than whites. Further research should address underlying reasons and whether these differences impact outcomes such as pain control, side effects and cost-effectiveness of care., (2003 by John Wiley & Sons, Ltd.)