title: Elderly patients with colorectal cancer are oncologically undertreated.
abstract: OBJECTIVE
  Colorectal cancer (CRC) is mainly a disease of the elderly. Our primary aim was to investigate if age had influence on treatment decisions in regards to surgery, referral to an oncologist and treatment by an oncologist.
  
  
  METHODS
  We identified patients with CRC in our department from 2004 through 2011 in the Danish Colorectal Cancer Group (DCCG) database. According to age ≤75 and >75 years multivariate logistic regression analysis was used on treatment decisions: surgery, referral to an oncologist and oncologic treatment. Independent variables were age, ASA score, tumorlocation, stage, gender and year of diagnosis. Additional analysis was performed for stage III and IV patients as a subgroup.
  
  
  RESULTS
  1701 patients were included of which 525 were >75 years of age. In multivariate analysis there was no association between age and chance of surgery. Older patients had a significantly lower odds ratio for referral to an oncologist (OR 0.624, p < 0.0001) and for oncological treatment if referred (OR 0.218, p < 0.0001). Being an elderly patient with stage III or IV CRC OR was 0.233 for referral- and for receiving treatment by an oncologist OR was 0.210 (p < 0.0001 for both), after adjusting for possible confounders.
  
  
  CONCLUSIONS
  Based on age elderly patients are on a lesser extent referred to an oncologist and get oncologic treatment less frequently. Surgically the elderly are not undertreated.
authors.affiliation: Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. Electronic address: asbojer@gmail.com.
authors.forename: A S
authors.initials: AS
authors.lastname: Bojer
authors.affiliation: Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Surgery, Copenhagen University Hospital Roskilde, Denmark.
authors.forename: O
authors.initials: O
authors.lastname: Roikjær
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000473:pathology / Q000628:therapy*; D016208:Databases, Factual; D003718:Denmark; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012737:Sex Factors; D055815:Young Adult
keywords: Aged; Colorectal neoplasms; Medical oncology; Multivariate analysis; Referral and consultation; Surgery