Treatment of the elderly colorectal cancer patient: SIOG expert recommendations

Abstract

Colorectal cancer (CRC) is one of the commonest malignancies of Western countries, with approximately half the incidence occurring in patients >70 years of age. Elderly CRC patients, however, are understaged, undertreated and underrepresented in clinical trials. The International Society of Geriatric Oncology created a task force with a view to assessing the potential for developing guidelines for the treatment of elderly (geriatric) CRC patients. A review of the evidence presented by the task force members confirmed the paucity of clinical trial data in elderly people and the lack of evidence-based guidelines. However, recommendations have been proposed on the basis of the available data and on the emerging evidence that treatment outcomes for fit, elderly CRC patients can be similar to those of younger patients. It is hoped that these will pave the way for formal treatment guidelines based upon solid scientific evidence in the future.

Characteristics Affecting Survival after Locally Advanced Colorectal Cancer in Quebec

“…Furthermore, some overestimation of the effect of guideline adherence could result from the intrinsic nature of the rer measure, in which the population-matched mortality rates used to estimate the expected-hazard death rates do not account for differences in general health and functioning because the rates are matched solely on age, sex, and calendar year. The cancer-specific mortality reduction associated with guideline adherence in lacrc patients generally ranges from 30% to 40% in observational studies, and most of those studies are also affected by some degree of confounding by underlying health status 2,21,[25][26][27][28] . A landmark pooled analysis of trials of fluorouracil-based adjuvant chemotherapy in stage iii colon cancer patients published in 2001 reported a 24% overall mortality reduction across all age groups 29 .…”

“…Second, our results provide the first evidence of an age-related discrepancy in treatment in this group of patients in Quebec. That observation highlights the importance of monitoring and understanding the nature of lacrc patient management to achieve assurance that all age groups receive optimal treatment, particularly now that several consensus statements have addressed crc management in elderly patients 2,37,38 . Third, there is reason to think that surgical approaches in crc have evolved considerably in Quebec since 2003, and our results provide a baseline for monitoring changes in surgical practice.…”

“…Given that the peak incidence of crc occurs in individuals 70-80 years of age 2 , the burden of crc will increase as the population ages. It is only in stage ii-iii rectum and stage iii colon cancers that chemotherapy, radiotherapy, or chemoradiation have been demonstrated to reduce cancer recurrence and death [3][4][5][6][7] .…”

Sequential biological therapies in metastatic colorectal cancer (mCRC): a cost comparison analysis for wildtype RAS mCRC patients in Brazil

“…These drug regimens are the most widely used treatment for mCRC in 1L and 2L in Brazil, and they are described in most treatment guidelines for metastatic disease (Van Cutsem & Oliveira, 2009;Sobrero et al, 2008;Peeters et al, 2010;Rautenberg et al, 2014;Van Cutsem et al, 2007;Chari et al, 2006;Glimelius & Oliveira, 2008;Glimelius & Oliveira, 2009;Nordlinger et al, 2009;Nordlinger et al, 2007;Papamichael et al, 2009;Van Cutsem & Oliveira, 2008). …”

The International Society of Geriatric Oncology Conference: Paris 2011

“…Therefore, the needs of the older cancer patient are not cur rently being met. This has indeed been the basis for the development of different task forces by the Society of Geriatric Oncology (SIOG) to cover all these deprived topics [1][2][3][4][5][6][7][8][9][10][11][12][13] and counter the fact that elderly cancer patients have too often been underserved in the area of drug development and have received less than optimal or substandard treatment even when data exists regarding effi cacious treatment. Many trials and retrospective evaluations use the age of 65 years as a cutoff to categorize patients as older or elderly.…”