Disparate Use of Chemoradiation in Elderly Patients With Localized Anal Cancer

Abstract

Background: The incidence of squamous cell carcinoma of the anus (SCCA) is increasing, particularly among the elderly (age ≥65 years). We sought to compare patterns of care for the treatment of SCCA in elderly versus nonelderly patients. Methods: Data for patients with stages I–III SCCA diagnosed from 2004 through 2015 were obtained from the National Cancer Database. Patients were categorized as having received standard-of-care (SOC) chemoradiation (CRT) with multiagent chemotherapy, non-SOC therapy, palliative therapy, or no treatment. Differences in treatment groups were tested using the chi-square test. We used logistic regression to identify predictors of SOC CRT and multiagent versus single-agent chemotherapy in patients receiving CRT. Propensity score matching was used to compare overall survival (OS) in elderly patients receiving multiagent versus single-agent chemotherapy for those receiving CRT. Results: We identified 9,156 elderly and 17,640 nonelderly patients. A lower proportion of elderly versus nonelderly patients (54.5% vs 65.0%; P<.0001) received SOC CRT than other treatments or no treatment. In multivariate analysis, elderly patients were 38% less likely than nonelderly patients to receive SOC CRT (odds ratio, 0.62; 95% CI, 0.58–0.65; P<.0001). A higher proportion of the elderly were treated with single-agent versus multiagent chemotherapy (16.9% vs 11.8%; P<.0001), which resulted in a >1.5-fold increase in the likelihood of elderly patients receiving single-agent chemotherapy (odds ratio, 1.52; 95% CI, 1.39–1.66) in multivariate analysis. After propensity score matching, 3-year OS was higher in elderly patients who received CRT with multiagent versus single-agent chemotherapy (77.1% vs 67.5%; hazard ratio, 0.78; 95% CI, 0.68–0.89; P=.0002). Conclusions: In this comprehensive study of patients with stages I–III SCCA, elderly patients were less likely than nonelderly patients to receive SOC CRT. The low proportion of elderly patients receiving SOC CRT with multiagent chemotherapy for localized anal cancer suggests that the optimal treatment approach for this vulnerable population remains undefined.

Construction and validation of a prognostic nomogram for anal squamous cell carcinoma

“…In addition, considering the adverse effects, when chemoradiotherapy was delivered, the elderly preferred to receive concurrent single-agent rather than multiagent chemotherapy, which resulted in a worse survival outcome. 10,20,21 In addition, compared to female patients, male patients had a worse survival outcome, which is consistent with the results of previous studies. 11,14,22,23 Some researchers have argued that women are more active in their health care, receive more cancer screening, and are more likely to be diagnosed at earlier stages of the disease.…”

“…In addition, considering the adverse effects, when chemoradiotherapy was delivered, the elderly preferred to receive concurrent single‐agent rather than multiagent chemotherapy, which resulted in a worse survival outcome. 10 , 20 , 21 …”

Clinical characteristics and prognosis of elderly patients with anal cancer

“…The reasons for choosing surgery in the elderly group may include the following: First, older adults often experience delays in CRT-related treatment and an increased probability of needing salvage abdominal perineal resection due to their inability to tolerate the toxic effects of radiotherapy. [13,14,25,35] Our study has some limitations. 1) This is a retrospective study and lacks data collection, including comorbidities, lifestyle habits, and detailed treatment information of elderly patients, and the availability of the above lacking data would likely improve the accuracy of the model.…”

Clinical characteristics and prognosis of elderly patients with anal cancer

“…Elderly patients were 38% less likely than nonelderly patients to receive CRT (OR, 0.62; 95%CI = 0.58-0.65; P < 0001) and had a.1.5-fold increase in the likelihood of elderly patients receiving single-agent (OR, 1.52; 95%CI = 1.39-1.66). [13] Another study indicated that 70-year-olds were 40% less likely to complete CRT than 50-year-olds and may be at increased risk of surgery or death. [14] Elderly patients receiving lowstandard radiotherapy with good tolerability can extend their life expectancy appropriately.…”

“…However, several studies have shown that older patients with anal cancer appear more suitable for less than standard, relatively simple treatment regimens than younger patients. [5,13,14] Given the high prevalence of anal cancer in the elderly, there is no consensus on the best treatment modality, which may require speci c management. The American Joint Committee on Cancer (AJCC) staging system is currently the dominant tool for predicting survival prognosis for many cancers, including anal cancer.…”