Treatment of colorectal cancer in the elderly

Abstract

Colorectal cancer has a high incidence, and approximately 60% of colorectal cancer patients are older than 70, with this incidence likely increasing in the near future. Elderly patients (> 70-75 years of age) are a very heterogeneous group, ranging from the very fit to the very frail. Traditionally, these patients have often been under-treated and recruited less frequently to clinical trials than younger patients, and thus are under-represented in publications about cancer treatment. Recent studies suggest that fit elderly patients can be treated in the same way as their younger counterparts, but the treatment of frail patients with comorbidities is still a matter of controversy. Many factors should be taken into account, including fitness for treatment, the wishes of the patient and family, and quality of life. This review will focus on the existing evidence for surgical, oncologic, and palliative treatment in patients over 70 years old with colorectal cancer. Careful patient assessment is necessary in order to individualize treatment approach, and this should rely on a multidisciplinary process. More well-designed controlled trials are needed in this patient population.

Surgery for Colorectal Cancer in Sri Lanka: Open to Laparoscopy

“…The median age of the study group was 59 years (range 25 to 90 years), which is lower than reported in most western literature (70 years, range 28 to 95) [10]. There was no marked difference in male to female ratio, 1.4: 1, in this study compared to other published data [11,12].…”

A comparative study of short-term outcomes of colorectal cancer surgery in the elderly population

“…Hence, lower PS score, and the virtue of being more elderly, may partly explain the lower use of adjuvant therapies in ≥75 group patients, which may affect longer term oncological outcomes (8, 22,24,25).…”

“…It is arguable that, although HDU/ITU cost are higher, providing them with more aggressive treatment might translate to an overall shorter hospital stay and better longer-term oncological outcomes. Therefore, the way forward might be to maximize preoperative fitness by providing a more holistic surgical care by the involvement of a multidisciplinary team -anaesthetists, intensivist, surgeon and geriatrician (24,26). This should be used in conjunction with less invasive laparoscopic techniques and the enhanced recovery programme after surgery postoperative pathway to decrease post-operative complications and hospital LOS (24,(29)(30)(31).…”

Underweight status predicts a poor prognosis in elderly patients with colorectal cancer

“…Approximately 60% of CRC patients are aged >70 years (2). The number of elderly individuals is increasing worldwide due to the increase in the average life span.…”