All-Cause and Cancer-Specific Death of Older Adults Following Surgery for Cancer

Abstract

Cancer (RESTORE-Cancer) GroupIMPORTANCE Cancer care has inherent complexities in older adults, including balancing risks of cancer and noncancer death. A poor understanding of cause-specific outcomes may lead to overtreatment and undertreatment.OBJECTIVE To examine all-cause and cancer-specific death throughout 5 years for older adults after cancer resection. DESIGN, SETTING, AND PARTICIPANTSThis population-based cohort study was conducted in Ontario, Canada, using the administrative databases stored at ICES (formerly the Institute for Clinical Evaluative Sciences). All adults 70 years or older who underwent resection for a new diagnosis of cancer between January 1, 2007, and December 31, 2017, were included. Patients were followed up until death or censored at date of last contact of December 31, 2018. EXPOSURES Cancer resection.MAIN OUTCOME AND MEASURES Using a competing risks approach, the cumulative incidence of cancer and noncancer death was estimated and stratified by important prognostic factors. Multivariable subdistribution hazard models were fit to explore prognostic factors. RESULTSOf 82 037 older adults who underwent surgery (all older than 70 years; 52 119 [63.5%] female), 16 900 of 34 044 deaths (49.6%) were cancer related at a median (interquartile range) follow-up of 46 (23-80) months. At 5 years, estimated cumulative incidence of cancer death (20.7%; 95% CI, 20.4%-21.0%) exceeded noncancer death (16.5%; 95% CI, 16.2%-16.8%) among all patients. However, noncancer deaths exceeded cancer deaths starting at 3 years after surgery in breast, prostate, and melanoma skin cancers, patients older than 85 years, and those with frailty. Cancer type, advancing age, and frailty were independently associated with cause-specific death.CONCLUSIONS AND RELEVANCE At the population level, the relative burden of cancer deaths exceeds noncancer deaths for older adults selected for surgery. No subgroup had a higher burden of noncancer death early after surgery, even in more vulnerable patients. This cause-specific overall prognosis information should be used for patient counseling, to assess patterns of over-or undertreatment in older adults with cancer at the system level, and to guide targets for system-level improvements to refine selection criteria and perioperative care pathways for older adults with cancer.

lncRNA AGAP2-AS1 Facilitates Tumorigenesis and Ferroptosis Resistance through SLC7A11 by IGF2BP2 Pathway in Melanoma

“…The incidence of melanoma is not high, accounting for about 4% of malignant tumors, but its malignant degree is generally high; in particular, the survival rate of patients with advanced metastatic melanoma is low [ 2 – 4 ]. Melanoma accounts for more than 70% of skin cancer-related deaths [ 5 , 6 ]. Oral and maxillofacial malignant melanoma, which can occur in the skin or mucosa, is a relatively high degree of malignant tumor [ 7 , 8 ].…”

Associations of Preoperative Frailty With Cancer and Noncancer Deaths of Older Adults Following Surgery for Cancer

“…To the Editor We read with great interest the study by Chesney et al 1 In this population-based cohort study using 8 health administrative databases in Ontario, Canada, among 82 037 older adults undergoing cancer surgery, 6443 (7.9%) had preopera-tive frailty and 55 491 (67.6%) experienced perioperative (preoperative and/or postoperative) chemotherapy or radiotherapy within 180 days before or after surgery. Of note, the results of this study identified that preoperative frailty was independently associated with cancer and noncancer deaths, while perioperative therapy was independently associated with noncancer death of older adults after cancer surgery.…”

“…If this variable of frailty or other variables closely associated with postoperative death were missing in some individual databases or some potentially important data for some patients were not recorded in these databases, how did the authors deal with the missing data? As we can see from eFigure 1 in Supplement 1 of this study, 1 only very few cases owing to missing data (n = 98) were excluded from this population-based cohort study (N = 87 086 for the whole cohort).…”

Adjuvant radiation therapy for older women with early-stage breast cancer: a propensity-matched SEER analysis

“…Breast cancer in older women was generally less aggressive and more indolent than in younger women. Meanwhile, a population-based cohort study conducted that the majority of death in older patients with early breast cancer were from causes like cardiovascular and cerebrovascular diseases other than breast cancer itself [ 2 ]. Therefore, de-escalating treatments for early-stage breast cancer has always been the treatment theme for aging patients [ 3 ].…”