Single-institution experience of colorectal cancer in the very elderly population (80 years and over)

Abstract

20542 Background: More than 70% of newly diagnosed cases of colon cancer are in individuals older than 70 years. However, limited data are available about treatment options in elderly patients, particularly in those over 80 years of age. As life expectancy increases and performance status is maintained, this subgroup of patients should play an important role in the design of colon cancer trials. Methods: To assess survival of very old patients based on the therapy received, we conducted a retrospective analysis of all consecutive colorectal patients, aged 80 and over, who were seen in one single institution (Mount Sinai Medical Center). Using our cancer registry database, we extracted data regarding age at diagnosis, site of tumor and pathology, stage, treatments and survival. Results: Over the last 26 years, 1390 patients (mean age at diagnosis was 85 years) have been seen in our institution. 73.8 % of the patients had surgery as the only treatment; of these, 248 (24%) subjects had only local tumor excision. Data on AJCC staging was available for 772 patients: 3.5% had in situ cancer, 34.3% had stage I disease, 30.1% stage II, 19.5% stage III and 12.6% stage IV. 98 patients received chemotherapy as part of their treatment. Stage II patients treated with chemotherapy (n=13) had a median overall survival of 75 months compared with 46 months for patients who had exclusively surgery (n=207). In stage III patients (n=139), chemotherapy significantly increased survival [25 versus 49 months (p=0.03)]. In stage IV (n= 64), there was no difference between the groups (8 versus 9 months, p=0.5). Conclusions: Despite the lack of recommendations from the US Preventive Services Task Force, colon cancer screening plays an important role in cancer prevention of elderly patients; as we observed that many tumors were detected in early stages. Elderly colon cancer patients tolerate and tend to benefit from chemotherapy, especially in early stages. Few randomized trials are designed exclusively for the elderly, and most trials do not allow the inclusion of elderly, despite good performance status. Cancer studies design to determine effective screening measures, treatment, and outcomes for this expanding age group are needed. No significant financial relationships to disclose.