Age impacts the pattern of care for elderly patients with rectal cancer

Guillerme, F.; Clavier, J; Nehme-Schuster, H.; Leroy, Valérie; Heitz, Damien; Schumacher, C.; Abdelghani, Méher Ben; Brigand, Cécile; Kurtz, Jean Emmanuel; Noël, Georges

doi:10.1007/s00384-013-1778-6

Cited by 21 publications

(21 citation statements)

References 16 publications

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“…Deviation from standard treatment in older patients with rectal cancer and comparable postoperative complication rates with younger patients are reported previously [7,[20][21][22][24][25][26]. In contrast to our findings, several studies did observe less surgical treatment performed in older patients [7,8,[20][21][22][23][24].…”

Section: Discussioncontrasting

confidence: 56%

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The impact of postoperative complications on health-related quality of life in older patients with rectal cancer; a prospective cohort study

Couwenberg

Beer

Intven

et al. 2018

Journal of Geriatric Oncology

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a b s t r a c t a r t i c l e i n f oObjectives: As result of the aging population and increasing rectal cancer incidence, more older patients undergo treatment for rectal cancer. This study compares treatment course, postoperative complications, and quality of life (QOL) between older and younger patients with rectal cancer and evaluates the impact of postoperative complications on QOL in the elderly. Materials and Methods: Patients with rectal cancer participating in a prospective colorectal cancer cohort and referred for radiotherapy between 2013 and 2016 were included. QOL was assessed with the cancer questionnaire of the European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30) before treatment and at three, six, and twelve months. Outcomes were compared between older patients (≥70 years) and younger patients (b 70 years) and stratified by presence of postoperative complications. Results: In total, 115 (33%) older patients and 230 (67%) younger patients were included. Compared to younger patients, older patients underwent significantly more often short-course radiation with delayed surgery (6.1% and 19.1% respectively) and less often chemoradiation (62.6% and 39.1% respectively), and were more likely to undergo a Hartmann procedure with permanent stoma (3.5% and 13.0% respectively) instead of sphincter-sparing surgery (43.9% and 29.6% respectively). Postoperative complication rates were similar (38.5% in older patients versus 34.7% in younger patients). Older patients had worse physical functioning at six and twelve months after diagnosis compared to younger patients. Presence of postoperative complications had a significant stronger impact on physical-and role functioning in older patients. Conclusion: Older patients undergo more often a tailored treatment approach for rectal cancer than younger patients. With this tailored approach, similar postoperative complication rates and QOL are achieved. However, postoperative complications have a larger negative impact on physical-and role functioning in older patients which indicates a need for better prediction of postoperative complications in the elderly.

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Section: Discussioncontrasting

confidence: 56%

“…In contrast to our findings, several studies did observe less surgical treatment performed in older patients [7,8,[20][21][22][23][24]. Also, higher rates of non-surgical complications, mainly cardiopulmonary, in older patients have been reported [7,8,20,26].…”

Section: Discussioncontrasting

confidence: 56%

The impact of postoperative complications on health-related quality of life in older patients with rectal cancer; a prospective cohort study

Couwenberg

Beer

Intven

et al. 2018

Journal of Geriatric Oncology

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“…Complete local tumor response after preoperative treatment in rectal cancer is considered an important prognostic indicator. In recent years, many efforts have been made aiming to increase response rate using hypofractionated radiotherapy or long course radiotherapy and concomitant chemotherapy with more effective drugs and regimens [16–18]. Delayed surgery (four to eight weeks interval) is usually performed after long-course preoperative chemoradiation in locally advanced rectal cancer.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Tumor Response after Short-Course Radiotherapy and Delayed Surgery for Rectal Cancer

et al. 2016

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PurposeNeoadjuvant therapy is able to reduce local recurrence in rectal cancer. Immediate surgery after short course radiotherapy allows only for minimal downstaging. We investigated the effect of delayed surgery after short-course radiotherapy at different time intervals before surgery, in patients affected by rectal cancer.MethodsFrom January 2003 to December 2013 sixty-seven patients with the following characteristics have been selected: clinical (c) stage T3N0 ≤ 12 cm from the anal verge and with circumferential resection margin > 5 mm (by magnetic resonance imaging); cT2, any N, < 5 cm from anal verge; and patients facing tumors with enlarged nodes and/or CRM+ve who resulted unfit for chemo-radiation, were also included. Patients underwent preoperative short-course radiotherapy with different interval to surgery were divided in three groups: A (within 6 weeks), B (between 6 and 8 weeks) and C (after more than 8 weeks). Hystopatolgical response to radiotherapy was measured by Mandard’s modified tumor regression grade (TRG).ResultsAll patients completed the scheduled treatment. Sixty-six patients underwent surgery. Fifty-three of which (80.3%) received a sphincter saving procedure. Downstaging occurred in 41 cases (62.1%). The analysis of subgroups showed an increasing prevalence of TRG 1–2 prolonging the interval to surgery (group A—16.7%, group B—36.8% and 54.3% in group C; p value 0.023).ConclusionsPreoperative short-course radiotherapy is able to downstage rectal cancer if surgery is delayed. A higher rate of TRG 1–2 can be obtained if interval to surgery is prolonged to more than 8 weeks.

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“…Both adjuvant and palliative chemotherapy are as efficacious in fit older patients as in younger patients. Although severe hematologic toxicity is increased in older patients treated with chemotherapy, this does not appear to increase the risk of other severe adverse events . However, there is no data on how age affects the efficacy of adjuvant chemotherapy in Chinese elderly patients with rectal cancer.…”

Section: Introductionmentioning

confidence: 99%

A population‐based study elicits a reverse correlation between age and overall survival in elderly patients with rectal carcinoma receiving adjuvant chemotherapy

Shan

Ren

et al. 2015

Clin Exp Pharma Physio

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Colorectal cancer is the third most common cancer and the fourth most common cause of cancer-related death globally. This population-based study aimed to explore the predictive factors that affected the overall survival of rectal cancer patients receiving adjuvant chemotherapy plus radical surgery using a Cox proportional hazards modeling approach. A total of 619 patients with rectal cancer who underwent surgery were enrolled between October 2006 and May 2013. Clinical characteristics of the patients were compared among the groups and potential prognostic factors were analyzed using the spss program, version 19.0. Patients aged ≥ 70 years have distinctive characteristics such as lager tumour size (≥ 5 cm), damaged micturition and higher incidence of diabetes compared to younger and middle-aged patients. Male gender, tumour size (≥ 5 cm), poor differentiation, later stage, adjuvant chemotherapy, damaged micturition, hypertension or diabetes are associated with a worse prognosis for rectal cancer patients (P < 0.05). However, smoking is a favourable factor to the patients (P = 0.018). Age of ≥ 70 years is an independent prognostic factor for patients with rectal cancer after surgery (P = 0.000) and elderly patients with Stage II and III disease receiving adjuvant chemotherapy show a favourable prognosis. The elderly patients who suffered from diabetes receiving adjuvant chemotherapy have a poor prognosis. Further prospective and large population studies are warranted to confirm the findings of this study.

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Age impacts the pattern of care for elderly patients with rectal cancer

Abstract: Treatment proposals and administered therapy differed according to age.

Cited by 21 publications

References 16 publications

The impact of postoperative complications on health-related quality of life in older patients with rectal cancer; a prospective cohort study

The impact of postoperative complications on health-related quality of life in older patients with rectal cancer; a prospective cohort study

Evaluation of Tumor Response after Short-Course Radiotherapy and Delayed Surgery for Rectal Cancer

A population‐based study elicits a reverse correlation between age and overall survival in elderly patients with rectal carcinoma receiving adjuvant chemotherapy

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