Colon Cancer Staging in Vulnerable Older Adults: Adherence to National Guidelines and Impact on Survival.
BACKGROUND
There is concern that elders are not adequately evaluated prior to colon cancer surgery. We sought to determine adherence with ACOVE-3 (Assessing Care of Vulnerable Elders) quality indicators for pre-operative staging prior to colectomy for colon cancer utilizing the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database (1992-2005).


METHODS
We determined the proportion of patients aged 75 and older who had preoperative staging prior to colectomy for colon adenocarcinoma. Preoperative staging was defined as abdominopelvic computed tomography or magnetic resonance imaging scan (SCAN) and colonoscopy or flexible sigmoidoscopy (SCOPE). Multivariate logistic regression identified predictors of adherence. Odds ratios were adjusted for comorbidity, socioeconomic status, and disease severity. The association of adherence to ACOVE-3 and survival was quantified.


RESULTS
Of the 37,862 patients, the majority were 75-84 years, 28% of the patients were ≥85 years. Regarding preoperative staging in the 6-month interval prior to surgical resection, 8% had neither SCAN nor SCOPE, 6% had only SCAN, 43% had only SCOPE, and 43% had both SCAN and SCOPE. Compared to patients who were not staged, those evaluated with either SCOPE alone or SCAN plus SCOPE had lower odds of 3-year mortality. Patients who were staged with SCAN alone had an increased odds of death compared to those who had neither SCAN or SCOPE.


CONCLUSIONS
These data demonstrate that the majority of vulnerable elders with colon cancer did not receive appropriate preoperative staging prior to resection. The findings also confirm that adherence to ACOVE-3 guidelines is associated with improved long-term survival.
University of Wisconsin Carbone Cancer Center ; University of Wisconsin Department of Medicine, Section of Hematology/Oncology.
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TB
Leal
University of Wisconsin Department of Medicine, Section of Hematology/Oncology.
T
T
Holden
University of Wisconsin Department of Medicine, Section of Hematology/Oncology.
L
L
Cavalcante
University of Wisconsin Health Innovation Program.
G O
GO
Allen
University of Wisconsin Health Innovation Program.
J R
JR
Schumacher
University of Wisconsin Health Innovation Program.
M A
MA
Smith
University of Wisconsin Carbone Cancer Center ; University of Wisconsin Department of Medicine, Section of Division of Gastroenterology and Hepatology.
J M
JM
Weiss
University of Wisconsin Department of Surgery.
H B
HB
Neuman
University of Wisconsin Carbone Cancer Center ; University of Wisconsin Department of Medicine, Section of Hematology/Oncology ; University of Wisconsin Health Innovation Program.
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NK
LoConte
ACOVE-3; SEER-Medicare; colon cancer; quality indicators; vulnerable elders