Management and survival analysis of elderly patients with a cancer in the digestive system who refused to receive anticancer treatments

Abstract

Treatment and management of cancers in elderly patients require some special considerations. A better understanding of how cancers progress in those elderly patients who have not received any anticancer treatments could better help us in treating these patients and in making end-of-life decisions. Over the past years, we had encountered 57 elderly patients, aged 75 to 94 years (87.6 on average), with a cancer in the digestive system, who refused to accept anticancer treatment but who did receive the best available supportive and palliative care. Clinicopathological data of these patients were analyzed. Of these 57 cases, 49 were at an advanced or late stage, while the remaining eight were at an early stage at the time of diagnosis. The median overall survival time of all the patients was 11 months, and almost the entire cohort manifested multiple-organ impairments. The average number of malfunctioning organs per patient was 3.68. After carefully predicting, and then preventing or managing complications, only 54.4% of the patients eventually died of multiple-organ functional failure. Nearly 18% of the single organ dysfunctions were finally well-controlled. Our data provide the first statistical information on the survival time and the direct cause of death of the elderly patients with a cancer in the digestive system not treated with chemotherapy or other direct anticancer interventions, but who did receive the best available supportive and palliative cares. During their struggle with cancer, elderly patients clearly could benefit from prophylactic interventions on organ dysfunction.

Refusal of medical treatment by older adults with cancer: a systematic review

“…There was just one study with a qualitative design (28), with a sample size of 28 patients. The sample size for quantitative studies ranged from 58 to 498,927 patients (24,29). Study quality ranged from poor to moderate for most studies (level 2 and 3 evidence; Appendix A.…”

“…There were two studies on lung cancer (18,22) and two on pancreatic cancer (10,13). Three studies included different types of cancer (miscellaneous) (15,24,29). Most of the studies were from the United States (9-14,17,22,23,27,29,30).…”

“…Most of the studies were from the United States (9-14,17,22,23,27,29,30). There were five Asian (15,18,20,21,24) and three European studies (16,25,28) There were no studies from Latin America.…”

“…Only two studies included elderly patients exclusively (24,28): one included only elderly women with breast cancer and the other one included elderly people with digestive cancer. The vast majority of studies (10)(11)(12)(13)(14)(15)(16)18,20,22,23,26,27,29) showed that being elderly was an important refusal factor.…”

A Cluster-Based Approach for Identifying Prognostic microRNA Signatures in Digestive System Cancers

“…The American Cancer Society estimates that there will be about 1,806,590 cancer cases diagnosed and 606,520 deaths from cancer in US in 2020 [2]. New diagnostic tools and treatment guidelines have been extensively studied and developed; however, the survival outcomes of some digestive tract tumors are not showing corresponding improvement [3][4][5]. Therefore, it is still urgent to develop more reliable prognostic methods for cancer treatment guidance, especially for some digestive tract cancers, which are often asymptomatic at the early stages [6][7][8][9][10].…”