The North Pacific Surgical Association
Disparities in the treatment of colon cancer in octogenarians

https://doi.org/10.1016/j.amjsurg.2008.12.018Get rights and content

Abstract

Background

Disparities in healthcare for the elderly are understudied, despite the increasing proportion of patients over 80 years of age. Advanced age is a principal risk factor for colorectal adenocarcinoma, but there are few data to guide treatment in the elderly patient population.

Methods

We performed a retrospective review of prospectively gathered data on 10,433 patients diagnosed with primary colon tumors between 1998 and 2004. We compared demographics, stage at diagnosis, and initial treatment between patients younger than 80 years and those age 80 years or older.

Results

Patients who were ≥80 years old made up 30% of the database. Older patients were less likely to have colectomy for advanced or metastatic disease than younger patients. Patients who were ≥80 years of age had fewer lymph nodes removed than younger patients (11 vs 10, P <.01). Older patients were significantly less likely to receive chemotherapy for every stage of colon cancer than younger patients. When older patients did get chemotherapy, it was more likely to be with a single agent. Multivariate analysis revealed that predictors of receiving chemotherapy for patients ≥80 years of age include living in an urban county, younger age, and worse stage at diagnosis.

Conclusions

Older patients make up a large portion of the patients treated for colon cancer and are treated less aggressively. While some of the treatment difference may be explained by medical factors, demographic factors affect treatment decisions as well.

Section snippets

Database

The Oregon Health & Science University Institution Review Board and the Oregon State Cancer Registry (OSCaR) Review Board both approved this study. OSCaR provided de-identified data on demographics, stage, and initial therapy for 10,433 patients with primary colon tumors diagnosed from 1998 through 2004. These data were entered into SPSS 15.0 (SPSS Inc., Chicago, IL). The age at diagnosis was used to categorize the patients into being 80 and older or 79 and younger. Rural and urban designations

Demographics

Of the 10,433 patients, 7,354 (70.5%) were ≤79 and 3,789 (29.5%) were ≥80 years old. Patients ≥80 years of age were more likely to be female and less likely to live in a rural county than the younger patients (Table 1).

Tumor characteristics and stage at diagnosis

Older patients were less likely to have stages in situ, regional to lymph node direct extension, or distant metastatic disease at presentation, but they were more likely than younger patients to have disease that was regional by direct extension or unknown stage (Figure 1).

Comments

The US population is becoming increasingly older, but data on how best to care for these patients are sparse. The purpose of this study was to examine disparities in treatment of colon cancer related to age using a large state database. Unfortunately, much of the key research guiding our current standard of care for diseases such as colon cancer has not included those over 80 years of age. This may in part be due to the ever-changing definition of “elderly.”

In our study, about a third of

Acknowledgment

The authors would like to acknowledge the hard work of the staff of the Oregon State Cancer Registry, Oregon Department of Human Services, Portland, OR.

References (13)

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Supported by the Oregon Clinical and Translational Research Institute (OCTRI), grant number UL1 RR024140 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.

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