Life Expectancy of Colorectal Cancer Patients With Geriatric Syndromes

Abstract

Colorectal cancer (CRC) is often diagnosed after age 70. Age and comorbidity reduce life expectancy independent of cancer stage and treatment. Geriatric syndromes (dementia, delirium, depression, falls, incontinence, pressure ulcers) are distinct morbidities that predict mortality in older adults independent of age and chronic disease; yet, we know little regarding their impact on life expectancy after CRC diagnosis. Aim: We assessed the prevalence of geriatric syndromes in a population-based sample of older CRC patients to quantify their impact onmedian life expectancy.Methods: This retrospective cohort study used the national administrative inpatient, outpatient and mortality data of veterans aged ≥ 60 years with CRC but no evidence of tumor spread beyond regional lymphatics. The prevalence of geriatric syndromes was assessed and a parametric proportional hazards model was used to examine their influence on mortality. Life expectancy was calculated using accelerated failure time models, stratified by advancing age, treatment and Deyo comorbidity score. Results: Of 60,265 veterans (98.4% male, 66.4% Caucasian, average age 74.5 [SD 7.8]), 29, 254 died during the period 10/01/03 to 10/01/08. Those who died were similar in age, gender, race, comorbidity, CRC site and receipt of therapy (chemotherapy, radiation, surgery) to those who lived. The prevalence of geriatric syndromes was 15%, with similar distributions of single versus multiple coexistent syndromes across cohorts. Falls were most frequent (61%), followed by dementia (12.8%), depression (11.7%) and incontinence (10.6%); however, pressure ulcers were most predictive of mortality (HR 2.5; 95% CI: 2.0-3.2). Life expectancy was strongly related to age and the presence of geriatric syndromes. For example, patients aged 60-69 with falls alone had an expected lifespan of 12.8 years, reduced to 6.9 years with coexistent psychiatric illness. Those 70-79 years with falls had a life expectancy of 7.1 years, shortened to 4.9 years with coexistent falls and psychiatric syndromes. In those ≥ 80 years, life expectancy was 4.8 years with falls, reduced by 40% with coexistent psychiatric illness, and limited to 1.4 years with falls, psychiatric illness and pressure ulcers. Chronic illness as identified by Deyo comorbidity score ≥ 1 further reduced life expectancy among patients of similar age and geriatric syndromes by an additional 16% to 50%. Conclusions: Geriatric syndromes are an important risk factor predicting mortality independent of age, treatment and comorbidity following CRC diagnosis. Gastroenterologists should identify them and consider their impact on life expectancy when discussing treatment options with older patients.