Age-related inequalities in colon cancer treatment persist over time: a population-based analysis

Hayes, Louise; Forrest, Lynne; Adams, Jean; Hidajat, Mira; Ben-Shlomo, Yoav; White, Martin; Sharp, Linda

doi:10.1136/jech-2018-210842

Cited by 22 publications

(32 citation statements)

References 17 publications

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“…[41] A lack of clinical guidelines for this age group across jurisdictions might also impact survival outcomes. Age-related inequalities have been identified for colon cancer [42] and the survival gap between elderly and middle-aged patients has been widening in Europe, particularly after the first year of diagnosis, an indication of differing treatment decisions in this cohort. [43] As around 40% of AC and SCC patients are diagnosed at ages greater than 75 years, there is a need for randomised controlled trials targeting older cancer patients to investigate the efficacy of cancer treatments in this age group and for clinicians to use comprehensive geriatric assessments when making treatment decisions in these patients.…”

Section: Discussionmentioning

confidence: 99%

International trends in oesophageal cancer survival by histological subtype between 1995 and 2014

Morgan

Soerjomataram

Gavin

et al. 2020

Gut

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IntroductionSurvival from oesophageal cancer remains poor, even across high-income countries. Ongoing changes in the epidemiology of the disease highlight the need for survival assessments by its two main histological subtypes, adenocarcinoma (AC) and squamous cell carcinoma (SCC).MethodsThe ICBP SURVMARK-2 project, a platform for international comparisons of cancer survival, collected cases of oesophageal cancer diagnosed 1995 to 2014, followed until 31st December 2015, from cancer registries covering seven participating countries with similar access to healthcare (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK). 1-year and 3-year age-standardised net survival alongside incidence rates were calculated by country, subtype, sex, age group and period of diagnosis.Results111 894 cases of AC and 73 408 cases of SCC were included in the analysis. Marked improvements in survival were observed over the 20-year period in each country, particularly for AC, younger age groups and 1 year after diagnosis. Survival was consistently higher for both subtypes in Australia and Ireland followed by Norway, Denmark, New Zealand, the UK and Canada. During 2010 to 2014, survival was higher for AC compared with SCC, with 1-year survival ranging from 46.9% (Canada) to 54.4% (Ireland) for AC and 39.6% (Denmark) to 53.1% (Australia) for SCC.ConclusionMarked improvements in both oesophageal AC and SCC survival suggest advances in treatment. Less marked improvements 3 years after diagnosis, among older age groups and patients with SCC, highlight the need for further advances in early detection and treatment of oesophageal cancer alongside primary prevention to reduce the overall burden from the disease.

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Section: Discussionmentioning

confidence: 99%

International trends in oesophageal cancer survival by histological subtype between 1995 and 2014

Morgan

Soerjomataram

Gavin

et al. 2020

Gut

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“…Cancer management in the oldest patients can be complex, given the high level of comorbidity, frailty, decline of functional status and limited life expectancy affecting this age group 5 . As the common exclusion of patients with cancer aged over the age of 65 from clinical trials 6 and the considerable heterogeneity in terms of health status and fitness among the oldest population, both undertreatment and overtreatment remain a concern 7 . As a consequence, the oldest patients have the lowest cancer‐specific survival relative to other age groups, 8‐10 and the survival gap is widening, partially because the oldest patients do not benefit as much from advances in cancer treatment as younger patients 8,9 …”

Section: Introductionmentioning

confidence: 99%

Estimated global cancer incidence in the oldest adults in 2018 and projections to 2050

Pilleron

Soto‐Pérez‐de‐Celis

Vignat

et al. 2020

Intl Journal of Cancer

211

117

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Using GLOBOCAN estimates, we describe the estimated cancer incidence among adults aged 80 years or older at the regional and global level in 2018, reporting the number of new cancer cases, and the truncated age‐standardised incidence rates (per 100 000) for all cancer sites combined for this age group. We also presented the five most frequent cancers diagnosed by region and globally among females and males aged 65 to 79 years old and 80 years or older. We, finally, estimated the number of new cancer cases in 2050, the proportion of cases aged 80 years or older, and the proportional increase between 2018 and 2050 by region, by applying population projections to the 2018 incidence rates. In 2018, an estimated 2.3 million new cancer cases (excluding nonmelanoma skin cancers) were aged 80 years or older worldwide (13% of all cancer cases), with large variation in the profiles at regional levels. Globally, breast, lung and colon were the most common cancer sites diagnosed in the oldest females, while prostate, lung and colon were most frequent in the oldest males. In 2050, an estimated 6.9 million new cancers will be diagnosed in adults aged 80 years or older worldwide (20.5% of all cancer cases). Due to the complexity of cancer management in the oldest patients, the expected increase will challenge healthcare systems worldwide, posing a tangible economic and social impact on families and society. It is time to consider the oldest population in cancer control policies.

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“…This observation reflects the effect of cancer management on survival. The treatment phase is a critical period where age inequalities occur 41 , likely because physicians are lacking evidence-based treatment strategies, especially in comorbid and oldest patients 42 . Even though surgery is the standard treatment in early-stage colon cancers 43,44 , older patients have a reduced likelihood of undergoing surgery 45–47 .…”

Section: Discussionmentioning

confidence: 99%

The impact of timely cancer diagnosis on age disparities in colon cancer survival in New Zealand

Pilleron

Maringe

Charvat

et al. 2020

Preprint

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Objective: We described the role of patient-related and clinical factors on age disparities in colon cancer survival among patients aged 50-99 using New Zealand population-based cancer registry data linked to hospitalization data. Design: We included new colon cancer cases diagnosed between 1 January 2006 and 31 July 2017, followed up to 31 December 2019. We linked these cases to hospitalisation data for the five years before the cancer diagnosis. We modelled the effect of age at diagnosis, sex, deprivation, comorbidity, and route to diagnosis on colon cancer survival by stage at diagnosis (localized, regional, distant, missing). Results: Net survival decreased as the age at diagnosis increased, notably in advanced stages and missing stage. The excess mortality in older patients was minimal for localised cancers, maximal during the first six months for regional cancers, the first 18 months for distant cancers, and over the three years for missing stages. The age pattern of the excess mortality hazard varied according to sex for distant cancers, the route to diagnosis for regional and distant cancers, and comorbidity for cancer with missing stages. Conclusion: The present population-based study shows that factors reflecting timeliness of cancer diagnosis most affected the difference in survival between middle-aged and older patients, probably by impacting treatment strategy. Because of the high risk of poor outcomes related to treatment in older patients, efforts made to improve earlier diagnosis in older patients are likely to help reduce age disparities in colon cancer survival in New Zealand.

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Age-related inequalities in colon cancer treatment persist over time: a population-based analysis

Cited by 22 publications

References 17 publications

International trends in oesophageal cancer survival by histological subtype between 1995 and 2014

International trends in oesophageal cancer survival by histological subtype between 1995 and 2014

Estimated global cancer incidence in the oldest adults in 2018 and projections to 2050

The impact of timely cancer diagnosis on age disparities in colon cancer survival in New Zealand

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