Surgical treatment of colon cancer in patients aged 80 years and older : analysis of 31,574 patients in the SEER-Medicare database.
BACKGROUND
Age-related disparities in colon cancer treatment exist, with older patients being less likely to receive recommended therapy. However, to the authors' knowledge, few studies to date have focused on receipt of surgery. The objective of the current study was to describe patterns of surgery in patients aged ≥ 80 years with colon cancer and examine outcomes with and without colectomy.


METHODS
Medicare beneficiaries aged ≥ 80 years with colon cancer who were diagnosed between 1992 and 2005 were identified from the Surveillance, Epidemiology, and End Results-Medicare database. Multivariable logistic regression analysis was used to assess factors associated with nonoperative management. Kaplan-Meier survival analysis determined 1-year overall and colon cancer-specific survival.


RESULTS
Of 31,574 patients, 80% underwent colectomy. Approximately 46% were diagnosed during an urgent/emergent hospital admission, with decreased 1-year overall survival (70% vs 86% for patients diagnosed during an elective admission) noted among these individuals. Factors found to be most predictive of nonoperative management included older age, black race, more hospital admissions, use of home oxygen, use of a wheelchair, being frail, and having dementia. For both operative and nonoperative patients, the 1-year overall survival rate was lower than the colon cancer-specific survival rate (operative patients: 78% vs 89%; nonoperative patients: 58% vs 78%).


CONCLUSIONS
The majority of older patients with colon cancer undergo surgery, with improved outcomes noted compared with nonoperative management. However, many patients who are not selected for surgery die of unrelated causes, reflecting good surgical selection. Patients undergoing surgery during an urgent/emergent admission have an increased short-term mortality risk. Because the earlier detection of colon cancer may increase the percentage of older patients undergoing elective surgery, the findings of the current study may have policy implications for colon cancer screening and suggest that age should not be the only factor driving cancer screening recommendations.
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792-7375, USA. neuman@surgery.wisc.edu
Heather B
HB
Neuman
Erin S
ES
O'Connor
Jennifer
J
Weiss
Noelle K
NK
Loconte
David Y
DY
Greenblatt
Caprice C
CC
Greenberg
Maureen A
MA
Smith
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002277:Carcinoma / Q000453:epidemiology / Q000208:ethnology / Q000601:surgery*; D003082:Colectomy / Q000706:statistics & numerical data*; D003110:Colonic Neoplasms / Q000453:epidemiology / Q000208:ethnology / Q000601:surgery*; D015897:Comorbidity; D016208:Databases, Factual / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D018426:SEER Program / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology