Abstract
Previous studies showed substantial improvement of survival rates in patients with cancer in the last two decades. However, lower survival rates have been reported for older patients compared to younger patients. In this population-based study, we analyzed treatment patterns and the survival of patients with breast cancer (BC) and colorectal cancer (CRC). Patients with stages I–III BC and CRC and diagnosed between 2003 and 2012 were selected from the Netherlands Cancer Registry (NCR). Trends in treatment modalities were evaluated with the Cochran-Armitage trend test. Trends in five-year overall survival were calculated with the Cox hazard regression model. The Ederer II method was used to calculate the five-year relative survival. The relative excess risk of death (RER) was estimated using a multivariate generalized linear model. During the study period, 98% of BC patients aged <75 years underwent surgery, whereas for patients ≥75 years, rates were 79.3% in 2003 and 66.7% in 2012 (p < 0.001). Most CRC patients underwent surgery irrespective of age or time period, although patients with rectal cancer aged ≥75 years received less surgery or radiotherapy over the entire study period than younger patients. The administration of adjuvant chemotherapy increased over time for CRC and BC patients, except for BC patients aged ≥75 years. The five-year relative survival improved only in younger BC patients (adjusted RER 0.95–0.96 per year), and was lower for older BC patients (adjusted RER 1.00, 95% Confidence Interval (CI) 0.98–1.02, and RER 1.00; 95% CI 0.98–1.01 per year for 65–74 years and ≥75 years, respectively). For CRC patients, the five-year relative survival improved over time for all ages (adjusted RER on average was 0.95 per year). In conclusion, the observed survival trends in BC and CRC patients suggest advances in cancer treatment, but with striking differences in survival between older and younger patients, particularly for BC patients.
Highlights
Together with the aging of the population in Western countries, the number of older people with cancer has increased considerably in the last decade [1]
Between 2003 and 2012, 127,146 patients were diagnosed with stages I–III breast cancer (BC) in the Netherlands, while 85,629 patients were diagnosed with stages I–III colorectal cancer (CRC) (Table 1)
As CRC patients are treated according to tumor location, i.e., colon cancer (CC) or rectal cancer (RC), we report the treatments received for CC and RC separately (Figure 3)
Summary
Together with the aging of the population in Western countries, the number of older people with cancer has increased considerably in the last decade [1]. In the Netherlands, breast cancer (BC) is the most common cancer in women, with an estimated incidence rate of 66 new cases per 100,000 women [2]. The incidence of BC is highest in patients aged 70–74 years (212 per 100,000 women) [2]. One of the most common cancers in both men and women is colorectal cancer (CRC), with an estimated incidence of 65 new cases per 100,000 persons. Its incidence increases with age (415 per 100,000 per persons in those aged 75–79 years) [2]. Though the group of older patients has increased considerably, evidence to guide treatment of these patients remains limited [3]. Many clinical trials exclude older patients from participating [4], and older patients who do participate in clinical trials may not be representative of the general older population, as clinical trials often exclude older patients with comorbidities or poor overall health [5]
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