title: Guideline recommended gastric cancer care in the elderly: insights into the applicability of cancer trials to real world.
abstract: BACKGROUND
  Given the underrepresentation of older persons in cancer trials, the association between increasing age and receipt of recommended gastric cancer care in the United States was examined.
  
  
  METHODS
  Using the 1998-2006 SEER database, 8637 Medicare-eligible patients, aged ≥ 65 years who underwent gastrectomy for nonmetastatic gastric adenocarcinoma were identified. Multivariate analyses was used to assess the effect of increasing age on receipt of recommended gastric cancer care (adequate lymph node evaluation [≥ 15 lymph nodes] and adjuvant radiation therapy for AJCC Ib-IVM0) and cancer-specific mortality controlling for covariates.
  
  
  RESULTS
  While 61% of gastric cancer operations were performed in patients ≥ 65 years, less than 30% received adequate lymphadenectomy or adjuvant radiation therapy. Older patients were less likely to receive adequate nodal evaluation and adjuvant radiotherapy (P < 0.0001). These findings persisted on multivariate analyses. Older age was also associated with worse cancer-specific mortality. Because an age-tumor location interaction for cancer mortality (P = 0.047) was observed, stratified analyses were performed which showed that the adverse effect of older age on cancer-specific mortality was augmented in proximal gastric cancers.
  
  
  CONCLUSIONS
  This population-based study showed significant age-based variations in gastric cancer care. These results should encourage assessment of generalizability of gastric cancer trials to this expanding population of elderly in the era of comparative effectiveness research.
authors.affiliation: Department of Surgery, The University of Minnesota, Minneapolis, MN, USA.
authors.forename: Vikas
authors.initials: V
authors.lastname: Dudeja
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.forename: Wei
authors.initials: W
authors.lastname: Zhong
authors.forename: Todd M
authors.initials: TM
authors.lastname: Tuttle
authors.forename: Selwyn M
authors.initials: SM
authors.lastname: Vickers
authors.forename: Eric H
authors.initials: EH
authors.lastname: Jensen
authors.forename: Waddah B
authors.initials: WB
authors.lastname: Al-Refaie
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic; D003695:Delivery of Health Care; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant; D018426:SEER Program; D013274:Stomach Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D015996:Survival Rate