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

• Published in: Critical reviews in oncology/hematology 2009-09, Vol.71 (3), p.249-257
• Main Authors: Aparicio, Thomas, Navazesh, Atika, Boutron, Isabelle, Bouarioua, Nadia, Chosidow, Denis, Mion, Mathieu, Choudat, Laurence, Sobhani, Iradj, Mentré, France, Soulé, Jean Claude
• Format: Article
• Language: English
• Subjects: Aged - statistics & numerical data; Aged, 80 and over; Antineoplastic agents; Antineoplastic Protocols - standards; Biological and medical sciences; Carcinoma - epidemiology; Carcinoma - mortality; Carcinoma - therapy; Cohort Studies; Colon cancer; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - mortality; Colorectal Neoplasms - therapy; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Comorbidity; Elderly; Female; Follow-Up Studies; Hematologic and hematopoietic diseases; Hematology, Oncology and Palliative Medicine; Humans; Male; Medical sciences; Pharmacology. Drug treatments; Prognostic factor; Rectal cancer; Retrospective Studies; Risk Factors; Survival Analysis
• ISSN: 1040-8428; 1879-0461
• DOI: 10.1016/j.critrevonc.2008.11.006

Abstract Background Several database studies report a lack of care in elderly patients with colorectal cancer. Purpose To describe the management of elderly patients admitted for colorectal cancer; to identify factors associated with standard management according to recommendations and to study factors influencing the survival. Patients and methods All consecutive patients over 75 years managed for a colorectal adenocarcinoma in our hospital from 1995 to 2000 and followed until 2006 were retrospectively included. The appropriateness of the management of their disease according to the recommendations available at that time was assessed. Several risk factors in receiving the standard cancer treatment were tested using univariate and then multivariate logistic regression. Risk factors of survival were studied using univariate and then multivariate survival analysis. Results One hundred and ten patients were included. Median age was 82 years (range: 75–96). A surgical treatment was performed in 96 patients. The median overall survival was 32 (1–108) months. A standard cancer treatment according to recommendations was performed in 53 (48%) patients: adjuvant chemotherapy in 6/23 patients with stage III tumour, palliative chemotherapy in 3/18 patients with stage IV tumour and adjuvant radiotherapy in 4/14 patients who had a rectal tumour resection. Multivariate analysis retains tumour stage I or II (OR = 7.6, 95% C.I. = [2.9–19.9], p < 0.0001) as the only factor associated with standard treatment and presence of metastasis (HR = 3.9, 95% C.I. [1.4–10.8], p = 0.005), and Charlson's score >3 (HR = 28.9, 95% C.I. [2.5–335.6], p = 0.001) as independent risk factors of poor survival. Conclusions Fifty two percent of elderly patients have had a sub-standard cancer treatment. The majority had a surgical treatment, but only a few received chemotherapy or radiotherapy. Metastasis, older age and Charlson's comorbidity score are the main prognosis factors of poor survival.