Guidance for Treating the Older Adults with Colorectal Cancer

Ioffe, Dina; Dotan, Efrat

doi:10.1007/s11864-023-01071-6

Cited by 8 publications

(3 citation statements)

References 116 publications

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“…However, the prognosis of elderly patients differs from that of younger individuals owing to the presence of other health conditions, functional disabilities, more advanced tumors, and a decreased ability to maintain internal balance. Elderly patients experience higher rates of complications and mortality following surgery as well as a less favorable overall outlook 3,20 . Given the complexities surrounding older adults with colon cancer, there is an urgent need for further research focusing on this demographic, particularly on those who have undergone surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

“…As the global population ages, a significant increase in the prevalence of colon cancer is expected among older individuals. In the United States alone, the elderly population (65 years and older) is expected to increase by 20% by 2030, leading to a parallel surge in colon cancer cases 3 . Additionally, the number of adults aged ≥ 85 years is expected to triple to 19 million by 2060, further contributing to the rise in colon cancer cases.…”

Section: Introductionmentioning

confidence: 99%

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Conditional Survival and Nomogram for Elderly Non-Metastatic Colon Cancer Patients Following Colectomy

Gao,

Wang,

Zhang

et al. 2024

Preprint

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Background: This study aimed to evaluate the conditional survival (CS) of elderly patients with non-metastatic colon cancer who underwent colectomy and build conditional nomograms that can accommodate varying survival periods and estimate survival rates. Methods: Data from 9302 patients between 2004 and 2017 were obtained from the Surveillance, Epidemiology, and End Results database. CS was used to assess overall survival and colon-specific survival rates in patients who survived beyond a certain time period. Cox regression was used to select factors for nomogram development, and performance was evaluated using area under the receiver operating characteristic curve (AUC), calibration plot, and decision curve analysis (DCA). Results: The 5-year conditional overall survival rates initially increased slightly but then decreased over time. The rates at different time points after diagnosis (baseline and 1-5 years) were 62.5, 63.2, 62.8, 62.1, 61.6, and 59.8%. In contrast, 5-year conditional colon-specific survival rates consistently improved over the same period. These rates were 78.1, 80.9, 84.2, 86.9, 89.3, and 90.9%, respectively. Nomograms were developed for baseline measurements and for patients who survived 1, 3, and 5 years. The performance of these nomograms, assessed using AUC, calibration curves, and DCA, indicated good predictive capabilities. Conclusion: CS provides valuable information on the medium- and long-term survival probabilities of elderly patients with non-metastatic colon cancer who underwent colectomy. The developed conditional nomograms allowed for the estimation of survival probabilities across different timeframes, facilitating a comprehensive understanding of prognosis and collaborative decision making.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Conditional Survival and Nomogram for Elderly Non-Metastatic Colon Cancer Patients Following Colectomy

Gao,

Wang,

Zhang

et al. 2024

Preprint

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“…Important strides have been made in recent years to increase efficacy or reduce toxicity in the treatment of both early and advanced CRC. However, there often remains limited prospective data to guide the management of older patients with CRC [3]. Older patients are frequently underrepresented in or excluded from clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Updates on the Management of Colorectal Cancer in Older Adults

O’Donnell,

Hubbard,

Jin

2024

Cancers

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Colorectal cancer (CRC) poses a significant global health challenge. Notably, the risk of CRC escalates with age, with the majority of cases occurring in those over the age of 65. Despite recent progress in tailoring treatments for early and advanced CRC, there is a lack of prospective data to guide the management of older patients, who are frequently underrepresented in clinical trials. This article reviews the contemporary landscape of managing older individuals with CRC, highlighting recent advancements and persisting challenges. The role of comprehensive geriatric assessment is explored. Opportunities for treatment escalation/de-escalation, with consideration of the older adult’s fitness level. are reviewed in the neoadjuvant, surgical, adjuvant, and metastatic settings of colon and rectal cancers. Immunotherapy is shown to be an effective treatment option in older adults who have CRC with microsatellite instability. Promising new technologies such as circulating tumor DNA and recent phase III trials adding later-line systemic therapy options are discussed. Clinical recommendations based on the data available are summarized. We conclude that deliberate efforts to include older individuals in future colorectal cancer trials are essential to better guide the management of these patients in this rapidly evolving field.

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SEOM-GEMCAD-TTD clinical guidelines for the adjuvant treatment of colon cancer (2023)

Pericay,

Montagut,

Reina

et al. 2024

Clin Transl Oncol

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Colorectal cancer (CRC) has a 5-year overall survival rate of over 60%. The decrease in the rate of metastatic disease is due to screening programs and the population’s awareness of healthy lifestyle. Similarly, advancements in surgical methods and the use of adjuvant chemotherapy have contributed to a decrease in the recurrence of resected disease. Before evaluating a patient’s treatment, it is recommended to be discussed in a multidisciplinary tumor board. In stage II tumors, the pathologic characteristics of poor prognosis must be known (T4, number of lymph nodes analyzed less than 12, lymphovascular or perineural invasion, obstruction or perforation, poor histologic grade, presence of tumor budding) and it is mandatory to determine the MSI/MMR status for avoiding administering fluoropyridimidines in monotherapy to patients with MSI-H/dMMR tumors. In stage III tumors, the standard treatment consists of a combination of fluoropyrimidine (oral or intravenous) with oxaliplatin for 6 months although the administration of CAPOX can be considered for 3 months in low-risk tumors. Neoadjuvant treatment is not consolidated yet although immunotherapy is achieving very good preliminary results in MSI-H patients. The use of ctDNA to define the treatment and monitoring of resected tumors is only recommended within studies. These guidelines are intended to help decision-making to offer the best management of patients with non-metastatic colon cancer.

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Guidance for Treating the Older Adults with Colorectal Cancer

Cited by 8 publications

References 116 publications

Conditional Survival and Nomogram for Elderly Non-Metastatic Colon Cancer Patients Following Colectomy

Conditional Survival and Nomogram for Elderly Non-Metastatic Colon Cancer Patients Following Colectomy

Updates on the Management of Colorectal Cancer in Older Adults

SEOM-GEMCAD-TTD clinical guidelines for the adjuvant treatment of colon cancer (2023)

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