Caring for Octogenarian and Nonagenarian Patients with Colorectal Cancer: What Should Our Standards and Expectations Be?

Kunitake, Hiroko; Zingmond, David S.; Ryoo, Jean J.; Ko, Clifford Y.

doi:10.1007/dcr.0b013e3181cdd658

Cited by 75 publications

(82 citation statements)

References 13 publications

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“…Prior work with CCR-linked data confirms that older patients with colon cancer who undergo surgical resection do have more comorbidities. 23 Because the CCR does not collect comorbidity data, the current study results may have overestimated the effect of age on chemotherapy receipt and its survival benefit. Third, the CCR does not collect information regarding specific chemotherapy regimens, durations, compliance, or referral to medical oncologists.…”

Section: Discussionmentioning

confidence: 84%

Adjuvant chemotherapy for stage III colon cancer in the oldest old

Abraham¹,

Habermann²,

Rothenberger³

et al. 2012

Cancer

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BACKGROUND: Randomized trials demonstrating the benefits of chemotherapy in patients with American Joint Committee on Cancer stage III colon cancer underrepresent persons aged 75 years. The generalizability of these studies to a growing elderly population remains unknown. METHODS: Using the California Cancer Registry for 1994 through 2008, the authors conducted a population-based study of postcolectomy patients aged 50 years to 94 years with stage III (N1M0) colon adenocarcinoma. A 2-sided chisquare test and Cochran-Armitage test for trend were used to compare patient and tumor characteristics associated with receipt of chemotherapy across age groups. Multivariate regression was used to assess the association between older age and receipt of chemotherapy. Kaplan-Meier methods and Cox proportional hazards modeling were used to evaluate the association between chemotherapy and mortality, with propensity score adjustment. RESULTS: Approximately 44% (12,382 patients) of the study cohort was aged 75 years. Persons aged 75 years were found to be less likely to have received adjuvant chemotherapy than those aged < 75 years (30% vs 68% in patients aged 50 years-74 years; P < .0001). On multivariate analysis, patients aged 75 years to 84 years were 13 times less likely, and those aged 85 years to 94 years were 24 times less likely, to have received chemotherapy as patients aged 50 years to 64 years. Nevertheless, age-stratified multivariate survival analyses indicated that chemotherapy provided comparable mortality reduction across age groups. CONCLUSIONS: The percentage of persons aged 75 years receiving adjuvant chemotherapy remains low despite demonstrated survival benefits. These findings deserve attention within the context of a patient's life expectancy, underlying comorbidities, and performance status, as well as clinician bias. The results of the current study support the call for phase II/III studies assessing the toxicities and benefits of adjuvant chemotherapy for the treatment of stage III colon cancer in the elderly.

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Section: Discussionmentioning

confidence: 84%

Adjuvant chemotherapy for stage III colon cancer in the oldest old

Abraham¹,

Habermann²,

Rothenberger³

et al. 2012

Cancer

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“…Most previous studies on postsurgical mortality in elderly colorectal cancer patients define elderly as >80 years. It has been established that "age" is a risk factor of early postsurgical mortality, and that short-term postsurgical mortality is significantly greater in older patients 32,33 . The life expectancy of a patient who does not undergo surgery cannot be predicted, but pain, poor general health, and complications caused by tumor obstruction are all factors that diminish the patient's quality of life if the tumor is not removed.…”

Section: Discussionmentioning

confidence: 99%

Impact of Comorbidities on the Outcomes of Older Patients Receiving Rectal Cancer Surgery

Chang¹,

Shih²,

Lin³

2012

International Journal of Gerontology

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s u m m a r yBackground: The decision to perform surgery on older patients often presents as an ethical dilemma. The purpose of this study is to investigate the impact of comorbidities on the clinical outcomes of older rectal cancer surgery patients, with the goal of enabling healthcare professionals to evaluate the risk of surgery for the treatment of cancer in older patients with comorbid chronic disease. Methods: This study included 320 patients >60 years of age who were treated from 2004e2009 at a medical center in northern Taiwan. Logistic regression and Cox proportional hazards regression were used to determine if various chronic diseases (e.g., hypertension, diabetes, cardiovascular disease, cerebrovascular disease) increase the risk of in-hospital complications and 1-year mortality. Results: In the multivariate analysis, the risk of in-hospital complications for diabetic patients was 3.43 times that of nondiabetic patients (95% confidence interval [CI]: 1.13e10.37). For patients with cerebrovascular disease, the risk was 4.99 times that of those without cerebrovascular disease (95% CI: 1.30e19.07). In addition, patients 80 years of age demonstrated significantly higher 1-year mortality rates (HR ¼ 3.49, 95% CI:1.18e10.30). However, a history of hypertension, diabetes, cardiovascular disease, or cerebrovascular disease was not a significant predictor of 1-year mortality. Conclusion: Older patients with comorbidities are at a higher risk of in-hospital complications following rectal cancer surgery, whereas the presence of comorbidities did not show a significant adverse effect on 1-year mortality in the present study. We suggest using population-based data to establish effective therapeutic strategies for treating each comorbidity.

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“…Emergency surgery carries a far higher risk than elective surgery [26], especially in older patients. Elective surgery is the preferred treatment, either for cure or for palliation, and after careful selection of patients [34,35].…”

Section: Discussionmentioning

confidence: 99%

Frailty Is an Independent Predictor of Survival in Older Patients With Colorectal Cancer

et al. 2014

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Background. Colorectal cancer (CRC) is prevalent in the older population. Geriatric assessment (GA) has previously been found to predict treatment tolerance and postoperative complications in older cancer patients. The aim of this study was to explore whether GA also predicts 1-year and 5-year survival after CRC surgery in older patients and to compare the predictive power of GA with that of established prognostic factors such as TNM classification of malignant tumors (TNM) stage and age. Materials and Methods. A cohort of 178 CRC patients aged 70 and older were followed prospectively. All patients went through elective surgery, and GA was performed presurgery. The GA resulted in patients being divided into two groups: frail or nonfrail. All patients were followed for 5 years or until death. Data were analyzed by Kaplan-Meier plots and the Cox proportional hazards model.

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Caring for Octogenarian and Nonagenarian Patients with Colorectal Cancer: What Should Our Standards and Expectations Be?

Cited by 75 publications

References 13 publications

Adjuvant chemotherapy for stage III colon cancer in the oldest old

Adjuvant chemotherapy for stage III colon cancer in the oldest old

Impact of Comorbidities on the Outcomes of Older Patients Receiving Rectal Cancer Surgery

Frailty Is an Independent Predictor of Survival in Older Patients With Colorectal Cancer

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