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Background: This study examined elderly stage II and III rectal cancer patients' adjuvant chemoradiation therapy adherence, trends in adherence over time, and the relation of levels of adherence to mortality.Methods: The authors studied 2886 stage II and III rectal cancer patients who had surgical resection and who appeared in 1992-1999 linked SEER-Medicare claims data. The authors compared measures of adjuvant radiation and chemotherapy receipt and completion between stage II and III patients. Adjusted risk of cancer-related 5-year mortality was calculated by multivariate logistic regression for different levels of chemoradiation adherence among stage II and III patients.Results: Of the 2886 patients, 45.4% received both adjuvant radiation and chemotherapy. Stage III patients were more likely to receive chemoradiation than stage II patients. The receipt of chemoradiation by stage II patients increased significantly from 1992 to 1999. Stage III patients were more likely to complete radiation therapy (96.6%), chemotherapy (68.2%), and both modalities (67.5%) than stage II patients (91.5%, 49.8%, 47.6%, respectively). Only a complete course of both radiation and chemotherapy for both stage II (relative risk [RR] 0.74; 95% CI, 0.54, 0.97) and III (RR 0.80; 95% CI, 0.65, 0.96) decreased the adjusted 5-year cancer mortality risk compared with counterparts with no adjuvant therapy.Conclusions: Even though stage II rectal cancer patients were less likely than stage III patients to receive and complete adjuvant chemoradiation, both patient groups in the general population had lower cancer-related mortality if they completed chemoradiation. These patients deserve support and encouragement to complete treatment. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated (i) how combining comorbid conditions identified from Medicare inpatient or physician claims into a single comorbidity index compared with three other comorbidity indices and (ii) the need for comorbid condition weights that are specific to different cancer sites. Methods: This observational study used the SEER-Medicare linked database, from which four cohorts of cancer patients were derived: breast (n = 26,377), prostate (n = 53,503), colorectal (n = 26,460), and lung (n = 33,975). We calculated two established (Charlson; NCI) and two new (NCI Combined; Uniform Weights) comorbidity indices, and used Cox proportional hazards models to assess their predictive ability. We also used a pooled dataset to examine the inclusion of cancer site-specific condition weights. Results: The four comorbidity indices all significantly predicted mortality, but the NCI and new NCI Combined indices showed the greatest contribution to model fit. The new NCI Combined index is simpler to use and statistically more efficient than the NCI index. Modeling further demonstrated the utility of cancer site-specific weights. Conclusions: Our results support the need for cancer site-specific comorbidity measures that employ empirically-derived condition weights. The new NCI Combined index is a refined, easier to implement comorbidity measurement algorithm appropriate for investigators using administrative claims databases to study four commonly-occurring cancers. [Copyright &y& Elsevier]