Half of elderly patients routinely treated for colorectal cancer receive a sub-standard treatment.
BACKGROUND
Several database studies report a lack of care in elderly patients with colorectal cancer.


OBJECTIVE
To describe the management of elderly patients admitted for colorectal cancer; to identify factors associated with standard management according to recommendations and to study factors influencing the survival.


METHODS
All consecutive patients over 75 years managed for a colorectal adenocarcinoma in our hospital from 1995 to 2000 and followed until 2006 were retrospectively included. The appropriateness of the management of their disease according to the recommendations available at that time was assessed. Several risk factors in receiving the standard cancer treatment were tested using univariate and then multivariate logistic regression. Risk factors of survival were studied using univariate and then multivariate survival analysis.


RESULTS
One hundred and ten patients were included. Median age was 82 years (range: 75-96). A surgical treatment was performed in 96 patients. The median overall survival was 32 (1-108) months. A standard cancer treatment according to recommendations was performed in 53 (48%) patients: adjuvant chemotherapy in 6/23 patients with stage III tumour, palliative chemotherapy in 3/18 patients with stage IV tumour and adjuvant radiotherapy in 4/14 patients who had a rectal tumour resection. Multivariate analysis retains tumour stage I or II (OR=7.6, 95% C.I.=[2.9-19.9], p<0.0001) as the only factor associated with standard treatment and presence of metastasis (HR=3.9, 95% C.I. [1.4-10.8], p=0.005), and Charlson's score >3 (HR=28.9, 95% C.I. [2.5-335.6], p=0.001) as independent risk factors of poor survival.


CONCLUSIONS
Fifty two percent of elderly patients have had a sub-standard cancer treatment. The majority had a surgical treatment, but only a few received chemotherapy or radiotherapy. Metastasis, older age and Charlson's comorbidity score are the main prognosis factors of poor survival.
Aparicio
Thomas
T
Service d'Hépato-Gastroentérologie, AP-HP, Hôpital Bichat, Université Denis Diderot, Paris 7, UFR de Médecine, Paris, France. thomas.aparicio@bch.aphp.fr
Navazesh
Atika
A
Boutron
Isabelle
I
Bouarioua
Nadia
N
Chosidow
Denis
D
Mion
Mathieu
M
Choudat
Laurence
L
Sobhani
Iradj
I
Mentré
France
F
Soulé
Jean Claude
JC
D000368:Aged / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D024221:Antineoplastic Protocols / Q000592:standards*; D002277:Carcinoma / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis