Effect of Adjuvant Chemotherapy on Elderly Colorectal Cancer Patients: Lack of Evidence

Nitsche, Ulrich; Stöß, Christian; Friess, Helmut

doi:10.1159/000479318

Cited by 18 publications

(11 citation statements)

References 55 publications

(72 reference statements)

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“…Possible reasons for the low utilisation rates in our study include the paucity of robust evidence supporting the benefit of such therapy in patients of all ages and in older adults (>70 years), referrer bias against the treatment resulting in reduced referrals for adjuvant chemotherapy, and concerns about the increased toxicity of chemotherapy in older adults [36]. Fit older adults with rectal cancer, however, benefit equally from adjuvant chemotherapy without a significant increase in toxicity [37].…”

Section: Discussionmentioning

confidence: 88%

Five Year Survival Outcomes of Prospectively Recorded Cohort Data for Older Adults versus Younger Adults with Resected Primary Rectal Cancer

Shafiei¹,

Beale²,

Blinman³

2021

JCT

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Background: Rectal cancer predominantly occurs in older adults. We aimed to compare the long-term outcomes of older adults (≥70 years) versus younger adults (<70 years) who had had a primary resection for stage I-IV rectal cancer. Methods: Consecutive patients who had resection of a primary rectal cancer between January 1, 2000 and December 31, 2010 were identified from a prospective database at the Concord Repatriation General Hospital and stratified into two age groups: <70 years and ≥70 years. Age-related differences in patients, cancer, and treatment characteristics were determined by Chi-square tests. 5-year Overall Survival (OS) and Cancer-Specific Survival (CSS) were determined by the Kaplan-Meier method and by multivariable Cox regression analysis. Results: Of 714 included patients, the mean age was 65.8 years (range, 21 -92 years). 407 (57%) patients were aged < 70 years and 307 (43%) were aged ≥ 70 years. Older age (>70 years) predicted more comorbidity (p < 0.001) and earlier stage (p = 0.01). Of the patients with stage III rectal cancer, older adults (>70 years), compared with younger adults (<70 years), received less neoadjuvant chemotherapy [7/86 (8.1%) vs 25/147 (17.0%), p = 0.058], less neoadjuvant radiotherapy [8/86 (9.3%) vs 42/147 (28.6%), p = 0.001] and less adjuvant chemotherapy [30/86 (34.9%) vs 117/147 (79.6%), p < 0.001]. Older age was associated with worse OS and CSS in stage III (p < 0.001 and p = 0.02 respectively). Adjuvant chemotherapy independently predicted improved OS (p < 0.001) and CSS (p = 0.008) regardless of age. Conclusion: Older adults who had had a resection of stage I-IV primary rectal cancer received less neoadjuvant and adjuvant therapy and had worse OS and CSS than their younger counterparts.

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Section: Discussionmentioning

confidence: 88%

Five Year Survival Outcomes of Prospectively Recorded Cohort Data for Older Adults versus Younger Adults with Resected Primary Rectal Cancer

Shafiei¹,

Beale²,

Blinman³

2021

JCT

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“…In part this may be because older patients had a more favourable histology with fewer patients with Stage III and IV disease. However, it may also reflect the lack of evidence that it benefits older patients as they are often excluded from oncology trials [35]. Across all age groups there were low rates of preoperative MDT discussion for colon (45.6%) and rectal (62%) cancer.…”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes following colorectal cancer resections in patients aged 80 years and over: results from the Australia and New Zealand Binational Colorectal Cancer Audit

et al. 2020

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Aim: The primary aim was to compare the 30-day morbidity and mortality in patients aged ≥80 years undergoing surgery for colorectal cancer with those aged <80 years. The secondary aim was to identify independent outcome predictors. Method:This was a retrospective study of patients undergoing surgery for colorectal cancer between January 2007 and February 2018. Patients were divided into those <80 years and those ≥80 years at the time of surgery. Data had been collected prospectively by the Australasian Binational Colorectal Cancer Audit and included patient demographics, site and stage of tumour, comorbidity, operative details, American Society of Anesthesiologists score (ASA), pathological staging, 30-day mortality and morbidity (medical and surgical). Univariate and multivariate analyses were used to identify predictors of 30-day morbidity and mortality.Results: During the study period, 4600 out of 20 463 (22.5%) patients were ≥80 years.They had a greater 30-day mortality after both colonic (97/2975 [3.3%] vs. 66/7010 [0.9%], P < 0.001) and rectal resections (50/1625 [3.1%] vs. 36/9006 [0.4%], P < 0.001) compared with younger patients. They also had an increased length of stay (colon cancer, 9 vs. 7 days; rectal cancer, 10 vs. 8 days; P < 0.001) and medical complications (colon cancer, 23.5% vs. 12.7%; rectal cancer, 25.2% vs. 11.2%; P < 0.001). Surgical complications were equivalent. Age ≥80 years was not an independent predictor of 30-day morbidity or mortality.Patients ≥80 years who were ASA 2/3 and had rectal cancer seemed to fare worse in terms of 30-day mortality (ASA 2, 22%, 95% CI 9%-36%, P < 0.001; ASA 3, 11%, 95% CI 4%-19%, P< 0.001). Conclusions:Postoperative morbidity and mortality are significantly greater in patients ≥80 years undergoing colorectal cancer surgery. Any recommendation for surgery in this age group should take into account patient comorbidity and not be based on age alone.

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“…There are no randomized trials performed specifically in elderly patients to answer the second most crucial question raised above, i.e., whether adjuvant therapy prevents recurrences sufficiently well in elderly patients to motivate the increased risks of toxicity seen in these patients. This has led to one conclusion that adjuvant treatment in elderly patients is not evidence-based [10].…”

Section: How To Measure Benefit? the Scientific Evidencementioning

confidence: 99%

Adjuvant Chemotherapy in Elderly Colorectal Cancer Patients

Glimelius

Osterman

2020

Cancers

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The value of adjuvant chemotherapy in elderly patients has been the subject of many overviews, with opinions varying from “not effective”, since randomized trials have not been performed, to “as effective as in young individuals”, based upon many retrospective analyses of randomized trials that have included patients of all ages. In the absence of randomized trials performed specifically with elderly patients, retrospective analyses demonstrate that the influence on the time to tumour recurrence (TTR) may be the same as in young individuals, but that endpoints that include death for any reason, such as recurrence-free survival (RFS), disease-free survival (DFS), and overall survival (OS), are poorer in the elderly. This is particularly true if oxaliplatin has been part of the treatment. The need for adjuvant chemotherapy after colorectal cancer surgery in elderly patients is basically the same as that in younger patients. The reduction in recurrence risks may be similar, provided the chosen treatment is tolerated but survival gains are less. Adding oxaliplatin to a fluoropyrimidine is probably not beneficial in individuals above a biological age of approximately 70 years. If an oxaliplatin combination is administered to elderly patients, three months of therapy is in all probability the most realistic goal.

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Effect of Adjuvant Chemotherapy on Elderly Colorectal Cancer Patients: Lack of Evidence

Cited by 18 publications

References 55 publications

Five Year Survival Outcomes of Prospectively Recorded Cohort Data for Older Adults versus Younger Adults with Resected Primary Rectal Cancer

Five Year Survival Outcomes of Prospectively Recorded Cohort Data for Older Adults versus Younger Adults with Resected Primary Rectal Cancer

Surgical outcomes following colorectal cancer resections in patients aged 80 years and over: results from the Australia and New Zealand Binational Colorectal Cancer Audit

Adjuvant Chemotherapy in Elderly Colorectal Cancer Patients

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