Elderly patients with colorectal cancer: Treatment modalities and survival in France from the ThInDiT observational cohort study.

Abstract

e14065 Background: More than 40% of the colorectal cancers (CRC) occur in elderly patients. Epidemiological data suggests that treatment modalities in this population differ from younger patients. We analysed the management of CRC patients in the real life in France using the French national health insurance system database. Methods: ThInDiT (Therapeutic Innovations in Digestive Tumors) is an observational cohort of 31 665 incident CRC diagnosed between April 1st and December 31th 2009 and registered in the French national health insurance system database. Using this cohort, we compared disease characteristics and treatment modalities within the first year of diagnosis between elderly (age >= 75) and younger patients (<75 years). Results: Elderly patients (pts) represented 42% (13 255/31 665) of the cases. They had more frequently an advanced stage at diagnosis (synchronous metastases: 20.5% vs 19.5% p=0.02, occlusion: 17% vs 11% p<0.0001). Pts with a localised disease (n=25 353): Surgery was performed in more than 80% of the cases in both age groups, delay between diagnosis and surgery was significantly shorter in elderly pts (8 vs 23 days p<0.0001) suggesting that emergency surgery was more frequent in this age group. An adjuvant chemotherapy (CT) was less frequently prescribed among elderly pts (15% vs 29% p<0.0001), 50% of the elderly received a 5FU alone whereas 79% of the younger pts had an oxaliplatin-based adjuvant CT. Pts with synchronous metastases (n= 6 312): Administration of palliative CT in elderly vs younger pts: 48% vs 85%, p<0.0001. CT regimen: LV5FU2 or capecitabine (30% vs 10%), Oxaliplatin-5FU (30% vs 34%), CT + bevacizumab (20% vs 35%) respectively. Elderly pts received less frequently a second or third line of CT than younger pts. Median overall survival was 8.4 months in elderly and 22.1 months in younger pts. Conclusions: Elderly patients represent more than 40% of incident CRC in France, they have a more advanced disease at diagnosis than younger pts. Treatment modalities are different among elderly and younger pts. Elderly pts have a worse prognosis than younger pts.