Cancer in Patients of and Above 90 Years: A Hospital-Based Retrospective Study

Abstract

Background: Cancer in a nonagenarian patient is rarely seen and there is always a moral dilemma for the family members and the patient as well of whether to opt for the treatment or not. Aim: The main aim was to identify the survival differences between treated and not treated nonagenarian cancer patients. Methods: This was a retrospective study of hospital-based cancer registry data from 2010 to 2016. The data of all nonagenarian cancer patients were analyzed for gender distribution, leading sites of cancer, stage distribution, types of treatment received, and survival. The survival was calculated from the date of first diagnosis. Descriptive statistics was used to present the results and presented up to single decimal place. Kaplan-Meier analysis was done to present the overall survival results and Cox-regression analysis was done to estimate the unadjusted HR. The P value for significance was set at < 0.05. SPSS v17.0 was used for carrying out the analysis. Results: Of 60,087 cancer patients registered during the study period, 146 (0.2%) patients were of 90 years and above. In males, hypopharynx in 19 (20.5%), lungs in 11 (10.3%), and esophagus in nine (8.4%) patients were top three leading sites. And in females, tongue in eight (20.5%), mouth in five (12.8%), and hypopharynx in four (10.3%) patients were the top leading sites. 60% patient data were in stages III and IV. Thirty seven (25.3%) patients received treatment, and 32 (86.4%) patients received radiotherapy alone. Five patients (13.5%) received combined modality of treatment. Two (5.4%) patients each received chemotherapy alone and surgery followed by radiotherapy for their cancer. Only one (2.5%) patient received concurrent chemo-radiotherapy. The median survival was nine months [confidence interval (CI) = 4.5-13.4]. The overall survival (OS) was 14.3% and the survival in the treatment group was 21.3% versus 7.7% in the Not Received, Abandoned, and Incomplete (NRAI) group (log rank (Mantel-Cox), P = 0.001). The unadjusted HR for NRAI group was 3.8 ( P = 0.003, CI=1.5-9.7). Conclusion: This analysis gives us some insight into the various types of cancer in the very old patients in our population. Selected nonagenarian cancer patients from our population with a favorable performance status should receive curative treatments in all possible ways. The improved overall survival and lower risk of death in nonagenarian cancer patients who received treatment in comparison with the NRAI group should aware the oncologist of the weighted benefits of curative treatment instead of plain palliation.