Summary Time trends in therapeutic approaches and in the prognosis of colon cancer for patients aged 75 years and above have been investigated in comparison with corresponding trends for younger patients using a population-based series of 2089 colon cancer patients diagnosed between 1976 and 1990 in the C6te-d'Or area (478 000 inhabitants), Burgundy, France. Significant progress has been achieved in the management of patients with colon cancer in both age groups, but trends have been more noticeable in patients aged 75 years and above. In the elderly, the proportion of cancers limited to the digestive tract wall showed a 3-year average increase of 2.8% (P = 0.02) and the frequency of curative surgery an average increase of 8.6% (P < 0.001), so that it was performed in 80% of cases in the last 3-year period. Operative mortality decreased by 2.5% between 3-year periods (P < 0.004). Crude 5-year survival rates in elderly patients increased from 15% in the 1976-78 period to 29% in the 1985-87 period (P < 0.001), the corresponding figures being 36% and 44% (P > 0.10) in younger patients.Keywords: colon cancer; stage at diagnosis; time trends; survival Colon cancer is a major problem in elderly patients. Incidence rates rise with age, and over 40% of cases occur in subjects over the age of 74. Recent studies have demonstrated an increase in the incidence of colon cancer in several areas of the Western world (Coleman et al, 1993) and, given the increasing life expectancy of Western populations, an ever-growing number of aged people is exposed to the risk of colon cancer. Age has often been considered as a negative factor in the prognosis for this cancer. However, raw survival data, from which such conclusions are usually drawn, overestimate mortality due to the malignancy under investigation, especially in elderly patients, for whom mortality owing to other causes is high, and tend to conceal the progress that has been achieved in the perioperative management of elderly patients over the past 15 years (Pillon et al, 1991). Data on therapeutic approaches and on the prognosis of colon cancer patients have mostly been provided by specialized hospital units, with unavoidable selection bias, especially for elderly patients. Outcome measuresThe spread of each malignancy at the time of diagnosis was classified, for resected cancers, according to Dukes (1932), as: limited to the digestive wall (Dukes A) (I, see tables); extension beyond the digestive wall (Dukes B) (II); and lymph node involvement (Dukes C) (Ill). In the absence of resection, cancers were classified as either metastatic (IV) or of undetermined stage (i.e. absence of detectable metastasis) (V). Treatment procedures were defined as: surgery for cure, i.e. complete tumour removal with tumour-free margins (1); palliative resection (II); palliative surgery with no tumour resection (i.e. colostomy or explorative laparotomy) (III); and medical treatment without surgery, i.e. chemotherapy, radiotherapy or purely palliative treatment (IV). As the impact of age and oth...

This study indicates that significant advances have been achieved at a population level in the treatment of rectal cancer in terms of diagnosis, continence-preserving procedures and survival.

Background: Acute myocardial infarction (AMI) in elderly patients is often unrecognized and associated with poor prognosis. Objectives: To investigate management and efficacy of reperfusion therapy to the elderly patients with AMI. Methods: From the January 1, 2001 to October 31, 2002, 964 patients with AMI were included in the French regional RICO survey. The patients were divided into three groups: younger (<70 years old), elderly (70–79 years old) and very elderly (≧80 years old). Results: Distribution of groups was 56, 27, and 16%, respectively. The longest time delay to first request for medical attention was found in the very elderly group (30 and 55 vs. 90 min, respectively, p < 0.05). Rate of lysis fell significantly with increasing age (35, 22 and 9%, respectively, p < 0.001) but the time delay to lysis was similar for the 3 groups. The proportion of patients who benefited from primary percutaneaous transluminal coronary angioplasty decreased with age (21, 15, 11%, respectively, p < 0.001), but time delay to balloon angioplasty was similar and no difference in mortality rate was observed between the three groups after reperfusion. The incidence of in-hospital cardiovascular events (cardiogenic shock and recurrent myocardial infarction/ischemia) and in-hospital mortality increased with age (5, 13, 17%, respectively, p < 0.001). Moreover, multivariate analysis showed that only ejection fraction and Killip >1 were independent predictive factors for in-hospital cardiovascular mortality, respectively (OR 5.15, 95% CI 2.08–12.74, p < 0.0001 and OR 3.81, 95% CI 1.90–7.65, p < 0.0001), whereas age, sex, diabetes and anterior location were not significant. Conclusion: Our data in an unselected population indicate that very elderly patients were characterized by increased pre-hospital delays and less frequent utilization of reperfusion therapy, although no difference in the mortality in reperfused patients could be observed between the three age groups.

This study indicates that significant advances have been achieved at a population level in the treatment of rectal cancer in terms of diagnosis, continence-preserving procedures and survival.