© 2002 by Oxford University Press
Journal of the National Cancer Institute, Vol. 94, No. 15, 1160-1167,
August 7, 2002
© 2002 Oxford University Press
ARTICLE |
Outcomes and Toxicity in African-American and Caucasian Patients in a Randomized Adjuvant Chemotherapy Trial for Colon Cancer
Affiliations of authors: A. D. McCollum, R. J. Mayer, C. S. Fuchs, Dana-Farber Cancer Institute, Boston, MA; P. J. Catalano, Dana-Farber Cancer Institute, Eastern Cooperative Oncology Group Statistical Center, Boston; D. G. Haller, University of Pennsylvania Cancer Center, Philadelphia; J. S. Macdonald, St. Vincent Clinical Cancer Center, New York, NY; A. B. Benson III, Division of Hematology-Oncology, Northwestern University, Chicago, IL.
Correspondence to: A. David McCollum, M.D., Dana-Farber Cancer Institute, 44 Binney St., Boston, MA (e-mail: amccollum{at}partners.org).
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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