title: Patterns of care and outcomes for elderly patients with metastatic colorectal cancer in Australia.
abstract: OBJECTIVE
  The elderly accounts for a large proportion of patients with metastatic colorectal cancer (mCRC). This study reviews patterns of care and outcomes for elderly patients with mCRC in the community setting.
  
  
  METHODS
  Elderly patients (≥ 65 years) with mCRC on the TRACC (Treatment of Recurrent and Advanced Colorectal Cancer) registry were identified. Treatment, bevacizumab-related adverse events, and overall survival (OS) were analysed by age cohorts, comparing those aged 65-74 vs. 75-84 vs. ≥ 85 years and correlated with potential prognostic factors. Factors affecting chemotherapy and bevacizumab administration were analysed using logistic regression analysis.
  
  
  RESULTS
  Of 1439 patients, 363, 352, and 106 were aged 65-74, 75-84, and ≥ 85 years, respectively. 584 (71%) patients received first-line chemotherapy, with chemotherapy use declining with advancing age (84%, 69%, and 34% in 65-74-, 75-84- and ≥ 85-year-olds, respectively). Seven (10%) patients aged ≥ 85 years were not treated with chemotherapy on the basis of age alone. Only 10 of 36 very elderly patients who received chemotherapy also received bevacizumab. Factors affecting bevacizumab administration included age, treatment location, and comorbidities. There was no impact of age on bevacizumab-related adverse events. Resection of metastatic disease occurred in 173 (21%) patients overall, with rates declining with age (26% vs. 21% vs. 6%).
  
  
  CONCLUSIONS
  Chemotherapy usage and resection of metastatic disease decline with advancing age. A minority of patients are not treated with systemic therapy due to advanced age alone. Our cohort suggests underutilisation of bevacizumab in older patients, but where given, toxicity rates did not increase with age.
authors.affiliation: Department of Medical Oncology, The Canberra Hospital, Canberra, Australia.
authors.forename: Sagun
authors.initials: S
authors.lastname: Parakh
authors.affiliation: Systems Biology and Personalised Medicine Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia; Department of Medical Oncology, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Hui-Li
authors.initials: HL
authors.lastname: Wong
authors.affiliation: Department of Medical Oncology, The Canberra Hospital, Canberra, Australia.
authors.forename: Rajat
authors.initials: R
authors.lastname: Rai
authors.affiliation: Department of Medical Oncology, The Canberra Hospital, Canberra, Australia; ANU Medical School, Australian National University, Acton, Australia.
authors.forename: Sayed
authors.initials: S
authors.lastname: Ali
authors.affiliation: Department of Medical Oncology, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Field
authors.affiliation: Department of Medical Oncology, Cabrini Health, Melbourne, Australia.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Shapiro
authors.affiliation: Systems Biology and Personalised Medicine Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Eastern Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: Rachel
authors.initials: R
authors.lastname: Wong
authors.affiliation: Department of Medical Oncology, Royal Hobart Hospital, Hobart, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Nott
authors.affiliation: Systems Biology and Personalised Medicine Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia; Department of Medical Oncology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Medical Oncology, Western Hospital, Melbourne, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Gibbs
authors.affiliation: Department of Medical Oncology, The Canberra Hospital, Canberra, Australia; ANU Medical School, Australian National University, Acton, Australia. Electronic address: desmond.yip@anu.edu.au.
authors.forename: Desmond
authors.initials: D
authors.lastname: Yip
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy; D003695:Delivery of Health Care / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D009362:Neoplasm Metastasis; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate
keywords: Bevacizumab; Chemotherapy; Colorectal; Elderly; Outcomes; Surgery