Abstract
BackgroundThere is significant debate as to where to draw the line between undertreating older rectal cancer patients and minimising treatment risks. This study sought to examine the use of radical rectal cancer treatments and associated outcomes in relation to age across the English NHS. MethodsPatient, tumour and treatment characteristics for all patients diagnosed with a first primary rectal cancer in England between 1st April 2009 and 31st December 2014 were obtained from the CORECT-R data repository. Descriptive analyses and adjusted logistic regression models were undertaken to examine any association between age and the use of major resection and post-surgical outcomes. Funnel plots were used to show variation in adjusted rates of major resection. ResultsThe proportion of patients who underwent a major surgical resection fell from 66.5% to 31.7%, amongst those aged <70 and aged ≥80 respectively. After adjustment, 30-day post-operative mortality, failure to rescue and prolonged length of stay were significantly higher among the oldest group when compared to the youngest. Patient reported outcomes were not significantly worse amongst older patients. Significant variation was observed in adjusted surgical resection rates in the oldest patients between NHS Trusts. The probability of death due to cancer was comparable across all age groups. ConclusionsOlder patients who are selected for surgery have good outcomes, often comparable to their younger counterparts. Significant variation in the treatment of older patients could not be explained by differences in measured characteristics and required further investigation.
Highlights
In 2016 over 9000 rectal cancers were diagnosed in the UK, with 22.5% of these occurring in older patients [1]
Rates of use of many important treatments, including major surgical resection, neoadjuvant radiotherapy and adjuvant chemotherapy, have all been shown to decrease with increasing age [7,8] and this has been hypothesised to be a contributory factor to UK rectal cancer survival rates lagging behind their European counterparts [4]
This study aims to use of these data to examine the use of radical rectal cancer treatments and their associated outcomes, and assess how these varied across the English National Health Service (NHS)
Summary
In 2016 over 9000 rectal cancers were diagnosed in the UK, with 22.5% of these occurring in older patients (aged 80) [1]. Increasing life expectancy means that the proportion of the UK population considered very old is predicted to double within the 25 years [2] This is likely to result in an increasing number of cancers diagnosed in old and very old people, making their treatment and disease outcomes an important focus for policy makers. Currently there is major concern about the under-treatment of older people This has arisen from a growing number of observational studies that have reported lower treatment rates with increasing age [4e6]. This study sought to examine the use of radical rectal cancer treatments and associated outcomes in relation to age across the English NHS. Significant variation was observed in adjusted surgical resection rates in the oldest patients between NHS Trusts. Significant variation in the treatment of older patients could not be explained by differences in measured characteristics and required further investigation
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