title: Age differences in presentation, diagnosis pathway and management of colorectal cancer.
abstract: BACKGROUND
  The gap in survival between older and younger European cancer patients is getting wider. It is possible that cancer in the elderly is being managed or treated differently than in their younger counterparts. This study aims to explore age disparities with respect to the clinical characteristics of the tumour, diagnostic pathway and treatment of colorectal cancer patients.
  
  
  METHODS
  We conducted a multicenter cross sectional study in 5 Spanish regions. Consecutive incident cases of CRC were identified from pathology services.
  
  
  METHODS
  From patient interviews, hospital and primary care clinical records, we collected data on symptoms, stage, doctors investigations, time duration to diagnosis/treatment, quality of care and treatment.
  
  
  RESULTS
  777 symptomatic cases, 154 were older than 80 years. Stage was similar by age group. General symptoms were more frequent in the eldest and abdominal symptoms in the youngest. No differences were found regarding perception of symptom seriousness and symptom disclosure between age groups as no longer duration to diagnosis or treatment was observed in the oldest groups. In primary care, only ultrasound is more frequently ordered in those <65 years. Those >80 years had a significantly higher proportion of iron testing and abdominal XR requested in hospital. We observed a high resection rate independently of age but less adjuvant chemotherapy in Stage III colon cancer, and of radiotherapy in stage II and III rectal cancer as age increases.
  
  
  CONCLUSIONS
  There are no relevant age disparities in the CRC diagnosis process with similar stage, duration to diagnosis, investigations and surgery. However, further improvements have to be made with respect to adjuvant therapy.
authors.affiliation: Unit of Research, Majorca Department of Primary Health Care, Balearic Institute of Health, Reina Esclaramunda 9, 07003 Palma de Mallorca, Spain. Electronic address: mesteva@ibsalut.caib.es.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Esteva
authors.affiliation: Unit of Research, Majorca Department of Primary Health Care, Balearic Institute of Health, Reina Esclaramunda 9, 07003 Palma de Mallorca, Spain.
authors.forename: Amador
authors.initials: A
authors.lastname: Ruiz
authors.affiliation: Majorca Cancer Registry, Department of Public Health, Balearic Department of Health, C/Jesús n 33, 07001 Palma de Mallorca, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Ramos
authors.affiliation: Health Consorcium of Barcelona, Parc Sanitari Pere Virgili - Edifici Mestral, Esteve Terrades, 30, 08023 Barcelona, Spain.
authors.forename: Monserrat
authors.initials: M
authors.lastname: Casamitjana
authors.affiliation: Canal Imperial Primary Care Centre, Paseo Colon 4, Zaragoza 50006, Spain.
authors.forename: María A
authors.initials: MA
authors.lastname: Sánchez-Calavera
authors.affiliation: Serreria II Primary Care Centre, Valencia Institute of Health, C/Pedro de Valencia 28, 46022 Valencia, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: González-Luján
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, A Coruña University, Complexo Hospitalario Universitario A Coruña, Xubias de Arriba, 84, Hotel de los pacientes 7ª planta, 15006 A Coruña, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Pita-Fernández
authors.affiliation: Unit of Research, Majorca Department of Primary Health Care, Balearic Institute of Health, Reina Esclaramunda 9, 07003 Palma de Mallorca, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Leiva
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, A Coruña University, Complexo Hospitalario Universitario A Coruña, Xubias de Arriba, 84, Hotel de los pacientes 7ª planta, 15006 A Coruña, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Pértega-Díaz
authors.affiliation: Nazareth Primary Care Centre, Parque Nazareth 16, 46024 Valencia, Spain.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Costa-Alcaraz
authors.affiliation: Evaluation and Clinical Epidemiology Department, Hospital del Mar, Passeig Marítim 25-29, 08003 Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Macià
authors.affiliation: Department of Gastroenterology, University Clinic Hospital of Valencia, Avda Blasco Ibañez 17, 46010 Valencia, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Espí
authors.affiliation: Lluis Saye Primary Care Centre, C/Torres i Amat 8, 08001 Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Segura
authors.affiliation: Fraga Primary Health Center, C/Hermana Andresa 2, 22520 Fraga, Huesca, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Lafita
authors.affiliation: Department of Gastroenterology, Hospital Can Misses, c/Corona, 32-36, 07800 Eivissa, Spain.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Novella
authors.affiliation: Department of Pathology, Hospital Miguel Servet, Paseo Isabel La Católica 1, Zaragoza, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Yus
authors.affiliation: Department of Psicology and Sociology. University of Zaragoza, Violante de Hungria 23, 50009 Zaragoza, Spain.
authors.forename: Barbara
authors.initials: B
authors.lastname: Oliván
authors.affiliation: Department of Public Health, Balearic Department of Health, Camí de Jesus 33, 07005 Palma de Mallorca, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Cabeza
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, A Coruña University, Complexo Hospitalario Universitario A Coruña, Xubias de Arriba, 84, Hotel de los pacientes 7ª planta, 15006 A Coruña, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Seoane-Pillado
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, A Coruña University, Complexo Hospitalario Universitario A Coruña, Xubias de Arriba, 84, Hotel de los pacientes 7ª planta, 15006 A Coruña, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: López-Calviño
authors.affiliation: Unit of Research, Majorca Department of Primary Health Care, Balearic Institute of Health, Reina Esclaramunda 9, 07003 Palma de Mallorca, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Llobera
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D013030:Spain
keywords: Colorectal cancer; Early diagnosis; Elderly; Health services accessibility; Primary health care; Quality of health care; Secondary care; Treatment