Age impacts the pattern of care for elderly patients with rectal cancer

Abstract

This study analyzed the current approaches for rectal cancer treatment in elderly patients. We retrospectively studied 240 rectal cancer patients who had undergone radiotherapy from 2000 to 2008. The ages of the patients ranged from 65 and 75years (group A, n = 127) and older than 75years (group B, n = 113). The distribution of the Charlson comorbidity index was similar between the two groups, but the ECOG performance status (PS) differed between the groups (66% of the patients of group A were PS 0, and 40% were PS 0 in group B (p < 0.0001)). The tumor stages were comparable between groups. The median age of the patients was 74.3years (range 65-90.6). Treatment was discussed during a multidisciplinary cancer team meeting before treatment for 55% of the cases in group A and 73% of the cases in group B (p < 0.001), and treatment proposals were in accordance with guidelines in 96% of the cases in group A and 76% of the cases in group B (p < 0.001). Group B patients received slightly less concurrent chemotherapy (35 vs. 30% for group A; p = 0.54), more hypofractionated radiotherapy (41 vs. 54% for group A; p = 0.064), less surgery (92 vs. 80% for group A; p = 0.014), and less adjuvant chemotherapy (34 vs. 10% for group A; p < 0.001). Finally, 80% of the patients in group A and 60% of the patients in group B received treatment in accordance with guidelines (p = 0.007) and in the logistic regression model. Non-metastatic patients who were aged below 75years were predicted for conformal management (HR = 0.323; 95% CI = 0.152-0.684) irrespective of their performance status, comorbidity, or disease stage. Treatment proposals and administered therapy differed according to age.