Impact of age on the use of adjuvant treatments in patients undergoing surgery for colorectal cancer: patients with stage III colon or stage II/III rectal cancer

Abstract

Background Many older patients don’t receive appropriate oncological treatment. Our aim was to analyse whether there are age differences in the use of adjuvant chemotherapy and preoperative radiotherapy in patients with colorectal cancer. Methods A prospective cohort study was conducted in 22 hospitals including 1157 patients with stage III colon or stage II/III rectal cancer who underwent surgery. Primary outcomes were the use of adjuvant chemotherapy for stage III colon cancer and preoperative radiotherapy for stage II/III rectal cancer. Generalised estimating equations were used to adjust for education, living arrangements, area deprivation, comorbidity and clinical tumour characteristics. Results In colon cancer 92% of patients aged under 65 years, 77% of those aged 65 to 80 years and 27% of those aged over 80 years received adjuvant chemotherapy (χ 2 trends < 0.001). In rectal cancer preoperative radiotherapy was used in 68% of patients aged under 65 years, 60% of those aged 65 to 80 years, and 42% of those aged over 80 years (χ 2 trends < 0.001). Adjusting by comorbidity level, tumour characteristics and socioeconomic level, the odds ratio of use of chemotherapy compared with those under age 65, was 0.3 (0.1–0.6) and 0.04 (0.02–0.09) for those aged 65 to 80 and those aged over 80, respectively; similarly, the odds ratio of use of preoperative radiotherapy was 0.9 (0.6–1.4) and 0.5 (0.3–0.8) compared with those under 65 years of age. Conclusions The probability of older patients with colorectal cancer receiving adjuvant chemotherapy and preoperative radiotherapy is lower than that of younger patients; many of them are not receiving the treatments recommended by clinical practice guidelines. Differences in comorbidity, tumour characteristics, curative resection, and socioeconomic factors do not explain this lower probability of treatment. Research is needed to identify the role of physical and cognitive functional status, doctors’ attitudes, and preferences of patients and their relatives, in the use of adjuvant therapies. Electronic supplementary material The online version of this article (10.1186/s12885-019-5910-z) contains supplementary material, which is available to authorized users.

Age disparities in stage‐specific colon cancer survival across seven countries: An International Cancer Benchmarking PartnershipSURVMARK‐2 population‐based study

“…The variation by age was significant in all countries with a consistently lower survival for older adults. For example, net survival was 81% (80-82) for 50 to 64 year olds and 58% (56-60) for 85 to 99 year olds in Australia, and 74% (73-74) and 39% (39)(40) Within each cancer stage, survival generally decreased with increasing age at diagnosis, with the greatest survival differences between age groups observed for those diagnosed with distant stage colon cancer.…”

“…For Stage III colon cancer, adjuvant chemotherapy is recommended regardless of age, but monotherapy will be preferred for older patients 36 . Yet, studies have shown that older patients with regional stage colon cancer are less likely to receive chemotherapy than younger patients 37‐39 . In general, for advanced stage, it is recommended to use less intensive combination therapies for unfit older patients 40 .…”

“…36 Yet, studies have shown that older patients with regional stage colon cancer are less likely to receive chemotherapy than younger patients. [37][38][39] In general, for advanced stage, it is recommended to use less intensive combination therapies for unfit older patients. 40 Some evidence suggests that fit older patients can be treated using the same chemotherapy regimens as younger adults.…”

Gender differences in stage at diagnosis and preoperative radiotherapy in patients with rectal cancer

“…All hospital Institutional Review Boards approved the study and all participants signed an informed consent form. For this sub-analysis, we have included the 770 patients with rectal cancer, 522 men and 248 women [22,23].…”

“…Patient characteristics: a) age: categorized into three groups (< 65, 65 to 80, > 80 years), employing the categorization used in previous articles based on this cohort [23]; b) screening status: patients being categorized as screen detected (if diagnosed after a positive fecal occult blood [FOB] test performed as part of population or opportunistic screening) or symptomatic (if diagnosed after having sought medical attention through primary care or emergency services); c) comorbidities: measured using the Charlson comorbidity index [25], classified into three groups (0, 1, and 2 or more); and d) diagnostic delay: number of days between the first contact with a physician and the first positive histological diagnosis, categorized into ≤ and > than 3 months; in patients referred from screening, the date of signing the FOB test report was considered the first contact.…”