Abstract
BackgroundMany older patients don’t receive appropriate oncological treatment. Our aim was to analyse whether there are age differences in the use of adjuvant chemotherapy and preoperative radiotherapy in patients with colorectal cancer.MethodsA prospective cohort study was conducted in 22 hospitals including 1157 patients with stage III colon or stage II/III rectal cancer who underwent surgery. Primary outcomes were the use of adjuvant chemotherapy for stage III colon cancer and preoperative radiotherapy for stage II/III rectal cancer. Generalised estimating equations were used to adjust for education, living arrangements, area deprivation, comorbidity and clinical tumour characteristics.ResultsIn colon cancer 92% of patients aged under 65 years, 77% of those aged 65 to 80 years and 27% of those aged over 80 years received adjuvant chemotherapy (χ2trends < 0.001). In rectal cancer preoperative radiotherapy was used in 68% of patients aged under 65 years, 60% of those aged 65 to 80 years, and 42% of those aged over 80 years (χ2trends < 0.001). Adjusting by comorbidity level, tumour characteristics and socioeconomic level, the odds ratio of use of chemotherapy compared with those under age 65, was 0.3 (0.1–0.6) and 0.04 (0.02–0.09) for those aged 65 to 80 and those aged over 80, respectively; similarly, the odds ratio of use of preoperative radiotherapy was 0.9 (0.6–1.4) and 0.5 (0.3–0.8) compared with those under 65 years of age.ConclusionsThe probability of older patients with colorectal cancer receiving adjuvant chemotherapy and preoperative radiotherapy is lower than that of younger patients; many of them are not receiving the treatments recommended by clinical practice guidelines. Differences in comorbidity, tumour characteristics, curative resection, and socioeconomic factors do not explain this lower probability of treatment. Research is needed to identify the role of physical and cognitive functional status, doctors’ attitudes, and preferences of patients and their relatives, in the use of adjuvant therapies.
Highlights
Many older patients don’t receive appropriate oncological treatment
The aims of this paper were a) to identify whether there are differences between age groups in the use of chemotherapy for stage III colon cancer and preoperative radiotherapy for stage II and III rectal cancer; and b) to assess whether these differences remain after adjusting for comorbidity, tumour characteristics, curative resection and social factors such as economic deprivation or living arrangements
We found no association of Charlson Comorbidity Index (CCI) or American Society of Anesthesiologists (ASA) with the use of radiotherapy, but family history was associated with a higher odds of use (OR = 1.5, 95% Confidence Interval (CI): 1.0–2.2), as was the tumour stage (OR = 2.8, 95% CI: 1.5–4.9)
Summary
Our aim was to analyse whether there are age differences in the use of adjuvant chemotherapy and preoperative radiotherapy in patients with colorectal cancer. A high percentage of older patients do not receive standard cancer treatments [2,3,4,5]. A European study found that 69% of patients under 65 years old and only 16% of those over this age received adjuvant chemotherapy for stage III colon cancer [4]. In Sweden, preoperative radiotherapy for rectal cancer was given to 64% of patients under 65 years old, to 50% of 65 to years old and to 15% of those years of age or older [7]. In Canada, Eldin et al observed that after adjusting for comorbidity and stage, age was the most important factor in determining the use of radiotherapy [9]. None of the multicentre studies has taken into account the inter-hospital variability both in clinical practice and in hospital area’s material deprivation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
