title: Treatment decision plans matter in elderly patients with gastrointestinal cancer: suboptimal or optimal?
abstract: OBJECTIVE
  Aging is an important risk factor for cancer. Molecular changes and defective immunity associated with aging result in increased susceptibility to many carcinogens of the gastrointestinal system (GIS). Comorbidities and changes in drug metabolism in elderly patients make the treatment of GIS cancers difficult.
  
  
  METHODS
  Between January 2009 and December 2012, a total of 790 patients diagnosed with GIS cancers were retrospectively evaluated. Among them, 357 patients aged ≥ 65 years constituted the study population in which the patient characteristics, disease location, TNM stage, ECOG PS, co-morbidities, chemotherapy regimens and overall survival (OS) were assessed.
  
  
  RESULTS
  The patient median age was 71 years (range 65-94). Cancer localizations were colorectal cancer (CRC), gastric cancer, and the pancreaticobiliary system (PBS) cancer in 178 (49.9%), 124 (34.7%), and 55 (15.4%) patients, respectively. A total of 260 (69%) patients underwent chemotherapy: 167 (64.3%) patients received optimal chemotherapy, and 93 (35.7%) suboptimal chemotherapy. The median OS was 47, 14, and 11 months in CRC, gastric, and PBS cancers, respectively. OS was better in the optimally-treated group than in the suboptimally-treated group among patients with all types of cancer. OS was 67 vs 19 months (p<0.001), 17 vs 8 months (p=0.004), and 12 vs 10 months (p=0.46) in CRC, gastric, and PBS cancers in the optimal and suboptimal chemotherapy groups, respectively. Multivariate analysis showed that the disease stage in all cancer types and optimal chemotherapy in the CRC group were important predictors of survival (p<0.001 and p=0.021, respectively).
  
  
  CONCLUSIONS
  Cancer is usually in advanced stage at the time of diagnosis in these elderly patients and screening programs might improve outcomes in this age group. Patients with GIS cancers (especially CRC and gastric cancer) should be encouraged to receive optimal chemotherapy regimens.
authors: Abant Izzet Baysal University, Faculty of Medicine, Department of Medical Oncology, Bolu, Turkey.
authors: Ummugul
authors: U
authors: Uyeturk
authors: Ibrahim
authors: I
authors: Turker
authors: Oznur
authors: O
authors: Bal
authors: Ayse
authors: A
authors: Demirci
authors: Ozlem
authors: O
authors: Uysal Sonmez
authors: Kaan
authors: K
authors: Helvaci
authors: Burcin
authors: B
authors: Budakoglu
authors: Ulku
authors: U
authors: Yalcintas Arslan
authors: Berna
authors: B
authors: Oksuzoglu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D012189:Retrospective Studies