Comorbidities Alone Do Not Explain the Undertreatment of Colorectal Cancer in Older Adults: A French Population‐Based Study

Quipourt, Valérie; Jooste, Valérie; Cottet, Vanessa; Faivre, Jean; Bouvier, Anne

doi:10.1111/j.1532-5415.2011.03334.x

Cited by 75 publications

(45 citation statements)

References 16 publications

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“…This is particularly notable since older cancer patients are often undertreated for cancer in practice and in hypothetical scenarios presented to physicians [19-21]. The present results are consistent with previous reports indicating that younger cancer patients are worried primarily about cancer recurrence [4, 12, 22].…”

Section: Discussionsupporting

confidence: 91%

What do cancer patients worry about when making decisions about treatment? Variation across racial/ethnic groups

Martin

Fouad

Oster

et al. 2013

Support Care Cancer

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Section: Discussionsupporting

confidence: 91%

What do cancer patients worry about when making decisions about treatment? Variation across racial/ethnic groups

Martin

Fouad

Oster

et al. 2013

Support Care Cancer

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“…Historically, increasing age has been the strongest determinant for patients not receiving adjuvant chemotherapy. [5][6][7][9][10][11]16 The age trend still remained significant after adjustment was made for potential confounders including comorbidity. However, there was no definite age identified above which chemotherapy should not be used.…”

Section: Discussionmentioning

confidence: 92%

Why adjuvant chemotherapy for stage III colon cancer was not given: Reasons for non-recommendation by clinicians or patient refusal

Gilbar

Lee

Pokharel

2016

J Oncol Pharm Pract

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Aim The aim of our study was to evaluate stage III colon cancer patients discussed at a multidisciplinary team meeting to identify reasons for clinicians not recommending adjuvant chemotherapy and reasons for patients declining recommended chemotherapy. Methods A retrospective, single institution Australian study was conducted on all surgically managed stage III colon cancer patients diagnosed at the regional cancer centre at Toowoomba Hospital between July 2010 and December 2014. Reasons why adjuvant chemotherapy was not recommended by the multidisciplinary team or following referral to a medical oncologist and patients' reasons for refusing chemotherapy despite medical oncology recommendation were determined. Results One hundred and nine patients were suitable for evaluation. Overall, 72 (66.1%) received adjuvant chemotherapy. Chemotherapy was not recommended in 25 (23.4%) of patients, with the majority (68%) having more than one cited reason. Multiple comorbidities and advanced age were the most common reasons for non-recommendation ( p < 0.01). Age alone was not a reason for not recommending chemotherapy. Twelve (11%) patients declined offered chemotherapy. The reasons for refusal were not detailed in the majority of patient charts (63.6%). Travel distance was not a factor in accepting or refusing chemotherapy. Conclusion Discussion at a multidisciplinary team meeting facilitates the identification of patients unsuitable for adjuvant treatment. The reasons for declining offered chemotherapy need to be assessed fully to ensure that patients' treatment preferences are balanced against the proven benefits of chemotherapy. Attendance at a regional cancer centre provides the opportunity for high standard care in the management of stage III colon cancer.

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“…Older patients generally derive a similar benefit from adjuvant therapy and can tolerate such regimens [17–20]. Despite this, older patients with colorectal cancer are less likely to be treated with adjuvant therapy [16, 17, 21–24]. Omission of adjuvant radiotherapy in older, medically fit rectal cancer patients may compromise not only local recurrent but survival as well.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Pelvic Radiotherapy in Patients with Stage II/III Rectal Cancer

Fitzgerald

Zervos

Wong

2013

Journal of Cancer Epidemiology

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High-level evidence supports adjuvant radiotherapy for rectal cancer. We examined the influence of sociodemographic factors on patterns of adjuvant radiotherapy for resected Stage II/III rectal cancer. Methods. Patients undergoing surgical resection for stage II/III rectal cancer were identified in SEER registry. Results. A total of 21,683 patients were identified. Majority of patients were male (58.8%), white (83%), and with stage III (54.9%) and received radiotherapy (66%). On univariate analysis, male gender, stage III, younger age, year of diagnosis, and higher socioeconomic status (SES) were associated with radiotherapy. Radiotherapy was delivered in 84.4% of patients <50; however, only 32.8% of those are >80 years. Logistic regression demonstrated a significant increase in the use of radiotherapy in younger patients who are <50 (OR, 10.3), with stage III (OR, 1.21), males (OR, 1.18), and with higher SES. Conclusions. There is a failure to conform to standard adjuvant radiotherapy in one-third of patients, and this is associated with older age, stage II, area-level of socioeconomic deprivation, and female sex.

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Comorbidities Alone Do Not Explain the Undertreatment of Colorectal Cancer in Older Adults: A French Population‐Based Study

Abstract: Further studies are warranted to identify more precisely the reasons for lower treatment rates for colorectal cancer in the older population.

Cited by 75 publications

References 16 publications

What do cancer patients worry about when making decisions about treatment? Variation across racial/ethnic groups

What do cancer patients worry about when making decisions about treatment? Variation across racial/ethnic groups

Why adjuvant chemotherapy for stage III colon cancer was not given: Reasons for non-recommendation by clinicians or patient refusal

Patterns of Pelvic Radiotherapy in Patients with Stage II/III Rectal Cancer

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