Differences in the Therapeutic Approach to Colorectal Cancer in Young and Elderly Patients

Abstract

After completing this course, the reader will be able to:1. Use patient age as only one consideration, along with tumor status and comorbidities, in deciding on treatment strategies for elderly colorectal cancer patients.2. Obtain and apply information regarding the medical, functional, mental, and social status of colorectal cancer elderly patients in order to make appropriate therapeutic decisions.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTPurpose. To analyze differences in the therapeutic approach to and tumor-related mortality of young and elderly colorectal cancer (CRC) patients. Patients and Methods. This was a descriptive study of a retrospective cohort, based on administrative databases, of all patients with CRC diagnosed or treated in our institution. We extracted data on sociodemographic characteristics, comorbidity, type of cancer, type of treatment received, survival time, and cause of death. We compared differences between a young group (YG) (age <75 years) and an older group (OG) (age >75 years) and assessed the variables associated with receiving different therapeutic options (multivariate analysis) and with survival time (Cox proportional hazards models).Results. The study included 503 patients (YG, 320; OG, 183), with mean ages of 63.1 years in the YG and 81.8 years in the OG. No differences were observed between the groups in degree of differentiation, extension, tumor stage, or comorbidity. After adjustment for gender, comorbidity, and tumor localization and extension, YG patients were more likely than OG patients to receive surgery, radiotherapy, and chemotherapy and less likely to receive palliative care. After a median follow-up of 36.5 months, YG patients had a longer tumor-specific survival time than OG patients (36.41 months vs 26.05 months). After further adjustment, the YG had a lower tumor-specific mortality risk (hazard ratio, 0.66) than the OG.Conclusion. In comparison with younger patients, elderly CRC patients are undertreated, mainly because of their age and not because of their tumor type or comorbidity. Elderly patients have a significantly shorter tumor-specific survival time, partially because of this undertreatment.

Surgery for Colorectal Cancer in Elderly Patients: How Could We Improve Early Outcomes ?

“…The geriatric CRC population is a very heterogeneous group, including pati ents with excellent health status and others with comorbid conditions, functional dependency, and limited life expectancy [8]. These issues could account for the fact that a significant proportion of elderly CRC patients is undertreated in comparison with younger patients [9][10][11]. Clinicians frequently have to decide whether major surgery is justified in elderly patients with a limited life expectancy.…”

“…Clinicians frequently have to decide whether major surgery is justified in elderly patients with a limited life expectancy. Effectiveness of surgery in elderly patients depends on whether it is done safely, allowing patients to return to productive lives, with a postoperative life expectancy that is improved by the surgical procedure [11]. Although improvements in surgical techniques, anaesthetic procedures, and postoperative care have all made surgery less hazardous, few elderly patients undergo resection for colorectal cancer in comparison with their younger counterparts [12].…”

Clinico-Pathological Caracteristics, Therapeutic Features and Post-operative Course of Colorectal Cancer in Elderly Patients

“…Published results for tumours pathological characteristics are conflicting: some studies show more advanced stages in old patients [6] whereas others do not [13].…”

Adjuvant chemotherapy for patients with ypT0-2N0-category after neoadjuvant chemoradiotherapy for rectal cancer

“…By contrast, a recent retrospective study showed that young patients with non-metastatic colorectal cancer after surgery had better long-term survival (21). This may in part be due to their good performance status and suitability for chemotherapy (24)(25)(26).…”