Inequalities in colon cancer treatment in Uruguay: Does age have a say?

Abstract

125 Background: Colorectal cancer (CRC) is the second most diagnosed cancer in men and women in Uruguay. Survival from CRC is known to be worse in those aged 65 years and older, despite more than 70% of cases occurring in this age group. It has been said that elderly cancer patients are often under-treated compared to younger ones, and that this unequal access to treatment in practice, despite universal access in theory, accounts for at least some of the reported survival difference. A better understanding of age-related inequalities in treatment would help to inform interventions to improve cancer control, therefore a retrospective study was undertaken to investigate if there are age-related inequalities in CRC care in Uruguay. Methods: Data on age, sex, tumor site and stage and treatments received (cancer-directed surgery and chemotherapy) were obtained for 1372 patients diagnosed with CRC. Likelihood of receipt of 1) cancer-directed surgery, 2) chemotherapy in surgical patients, 3) chemotherapy in non-surgical patients by age, adjusting for sex, cancer stage, was examined. Results: More than two-thirds (67%) of our population were aged 60 years or older at diagnosis and a slightly higher proportion were men (53%). Seventy six percent received cancer directed surgery, either in a curative or palliative intent. When analyzing patients with stage I-III cancers, 81% of patients received curative intent surgery. Those in the oldest age group (80+ years) were significantly less likely to be operated than those in the <60 years age group (p 0.002) specially if the tumor was in the sub peritoneal rectum. In relation to receipt of chemotherapy in surgical patients, similar age patterns were observed, although in a much more extreme manner (p <0.001). Increasing age was also strongly associated with reduced likelihood of receiving systemic therapy, with a higher percentage of patients <60 years old receiving at least palliative chemotherapy in comparison to the 80+ year age group (p <0,001). No differences in relation to gender or tumour location were observed. Conclusions: Age remains a major factor in treatment decisions. Research is needed both to identify the most effective treatment for colon cancer in older populations and to understand clinicians’ decision-making processes to ensure equitable access.