Ageism in rectal carcinoma? Treatment and outcome variations.
BACKGROUND
Rectal cancer adjuvant and neo-adjuvant therapies are associated with improved survival and local control rates. Concerns regarding adverse treatment effects tend to reduce administration in the elderly-the very population this disease affects.


OBJECTIVE
To determine the extent to which age alters rectal cancer treatment and its outcome.


METHODS
Using the population based provincial cancer registry, patients with adenocarcinoma of the rectum diagnosed between 1991 and 1998 were identified. From this cohort, a random subsample of patients seen at the regional cancer center were selected for detailed analysis. Demographic and clinical data between the provincial cohort and the subsample were compared for homogeneity. Log rank tests and Kaplan-Meier survival estimates were carried out on the subsample.


RESULTS
The population cohort (n = 1979) and the subsample (n = 259) were similar in age, sex, and treatment distributions. Elderly patients (>/=75 yr) made up 23% of the rectal cancer population in Alberta. Age had a highly significant (p = 0.001) impact on whether patients received surgery alone or had surgery plus chemoradiotherapy. This corresponded to a considerable survival advantage for those elderly patients who did receive multimodality therapy (p = 0.008).


CONCLUSIONS
The advantage of multimodality therapy in rectal cancer is confirmed in this populationbased study. Although a significant number of elderly patients are fit enough to tolerate major surgery they are being denied adjuvant therapies, presumably on the basis of potentially high treatment-related complication rates, with a subsequent reduction in survival. Strategies must be developed to ensure that maximum treatment benefit is obtained without increased harm in the elderly rectal cancer patient.
Dharma-Wardene
Melina W
MW
Division of Epidemiology, Prevention and Screening, Cross Cancer Institute and University of Alberta, Edmonton, Alberta, Canada.
de Gara
Christopher
C
Au
Heather-Jane
HJ
Hanson
John
J
Hatcher
Juanita
J
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002277:Carcinoma / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery; D012042:Registries / Q000706:statistics & numerical data*; D016019:Survival Analysis