Half of elderly patients routinely treated for colorectal cancer receive a sub-standard treatment

Aparicio, Thomas; Navazesh, Atika; Boutron, Isabelle; Bouarioua, Nadia; Chosidow, Denis; Mion, Mathieu; Choudat, Laurence; Sobhani, Iradj; Soulé, J C

doi:10.1016/j.critrevonc.2008.11.006

Cited by 95 publications

(60 citation statements)

References 31 publications

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“…These figures are consistent with data from other series of colorectal cancer patients, in which the percentage of patients over 75 years of age ranges between 22% and 45% (5,14). The increase of female patients as a function of age is also found in other series and is explained by the higher life expectancy of women (15).…”

Section: Discussionsupporting

confidence: 81%

“…In other series, complicated forms of the disease reached figures similar to our data, in patients aged 80 or above (5,6,14,18,20).…”

Section: Discussionsupporting

confidence: 77%

“…The increase of female patients as a function of age is also found in other series and is explained by the higher life expectancy of women (15). As has been described previously (5,(16)(17)(18)(19)(20), more than 60% of patients aged 80 or older had associated comorbidities. Similarly, there was an increase in perioperative risk (ASA grade) with age.…”

Section: Discussionsupporting

confidence: 61%

“…In particular, colorectal cancer represents more than 50% of the new cases of cancer in nonagenarians. Nevertheless, there are few of publications focusing on this disease in octogenarians, and hardly any relating to patients older than 90 years of age (2)(3)(4)(5)(6). Indeed, there is little in literature concerning the impact of surgery in general on octogenarians and nonagenarians (7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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Colorectal cancer in the elderly: characteristics and short term results

Arenal-Vera¹,

Tinoco-Carrasco²,

del-Villar-Negro

et al. 2011

Rev. esp. enferm. dig.

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Objective: to analyse the characteristics of colorectal cancer in elderly patients and to assess the outcomes of treatment.Materials and methods: the study included 1924 patients diagnosed with colorectal cancer during a 22 year period . We analysed patient clinical and demographic characteristics as well as their treatment and its outcome.Results: there was an increase in emergency surgery with age, increasing from 13% among patients under 80 years of age to 47% in those over 90 years of age (p = 0.0001). On the other hand, the overall percentage of patients who underwent surgical treatment decreased from 96% in patients younger than 80 years of age, to 85% and 59% in octogenarians and nonagenarians, respectively (p = 0.0001), and there was a similar pattern in the rates of curative surgery among patients who underwent surgery. The overall mortality of patients who underwent surgery was 8% (141 out of 1,769), increasing from 4% in patients younger than 70 years of age to 25% in those over 90 (p = 0.0001). Multivariate analysis showed that the factors associated with mortality were the emergency nature of the surgery (p = 0.001), the ASA grade (p = 0.0001), and the presence of systemic complications (p = 0.0001), the weight of age decreasing significantly with respect to the univariate analysis (p = 0.013).Conclusions: there is an increase in the rate of complicated forms of colorectal cancer with increasing age of patients. In addition, there is a dramatic decrease in the rate of curative tumour resection with increasing age. Intraoperative mortality for colorectal cancer in octogenarians and nonagenarians is more closely related to the nature and intent of the surgery (elective or emergency; palliative or curative), the perioperative risk (ASA grade), and severe systemic complications, than to age.

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Section: Discussionsupporting

confidence: 81%

“…In other series, complicated forms of the disease reached figures similar to our data, in patients aged 80 or above (5,6,14,18,20).…”

Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Colorectal cancer in the elderly: characteristics and short term results

Arenal-Vera¹,

Tinoco-Carrasco²,

del-Villar-Negro

et al. 2011

Rev. esp. enferm. dig.

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“…Possible reasons of treatment disparities include comorbidities, higher refusal rates, declining of functional and mental status, hospital volume and socioeconomic factors. Both physicians and patients may perceive a lowering of treatment efficacy and tolerance with advancing age [16] .…”

Section: Disparities Of Adjuvant Treatment Indication In the Elderlymentioning

confidence: 99%

Adjuvant treatment of colorectal cancer in the elderly: Where do we come from and where are we going?

Bartolomeo

Pietrantonio

Biondani

et al. 2012

JST

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Objective: Colorectal cancer is the third most commonly reported cancer in the world and about 50% of patients are diagnosed over the age of 70 years. The authors discuss age-related changes in organ function, comorbidities and frailty in the elderly, and their impact on chemotherapy toxicity. Methods:The authors review data from observational studies and subgroup analyses of randomized clinical trials on adjuvant chemotherapy in elderly colorectal cancer patients. Results: Several large population-based studies suggest that adjuvant chemotherapy is offered less frequently to elderly patients, although in recent years the prescription patterns tended to significantly increase. In fact, data from retrospective analyses of randomized trials indicate that elderly stage III colorectal cancer patients may get similar clinical advantage from adjuvant treatment with fluoropyrimidines, although major comorbidities may substantially limit life expectancy and minimize the survival benefits. The use of oxaliplatin-based regimens needs to take into account the individual risk/benefit profile due to lack of unequivocal evidence of positive literature data. Conclusions:Adjuvant chemotherapy of colorectal cancer should be investigated by prospective trials specifically designed for the elderly. Fit elderly patients should be offered standard adjuvant treatments, while modified schedule, attenuated doses or even treatment omission can be offered to more frail patients.

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