title: Patterns of care and treatment outcomes in older patients with biliary tract cancer.
abstract: BACKGROUND
  Although biliary tract cancers (BTC) are common in older age-groups, treatment approaches and outcomes are understudied in this population.
  
  
  METHODS
  Data from 913 patients diagnosed with BTC from January 1987 to July 2013 and treated at Princess Margaret Cancer Center, Toronto were analyzed. The differences in treatment patterns between older and younger patients were explored and the impact of age, patient and disease characteristics on survival outcomes was assessed.
  
  
  RESULTS
  Three hundred and twenty one patients ≥ 70 years were identified. Older patients were more likely to receive best supportive care, 40% (n = 130), compared to younger patients 26% (n = 154); p < 0.0001. On multivariable analysis, factors associated with receipt of surgery included stage I/II disease (p < 0.0001) and ECOG PS < 2 (p < 0.0001). Older age was not associated with lack of surgical intervention. In comparison, older age was associated with non-receipt of palliative chemotherapy (p = 0.0007). Similar survival benefit from treatment was seen in older and younger patients. Of 626 patients that underwent either surgery or palliative chemotherapy (n = 188), the median survival was 21.1 months (95% CI 19.0-27.9) in patients >70 years of age, and 21.1 months in younger patients (n = 438) (95% CI 19.5-24.5).
  
  
  CONCLUSIONS
  In this large retrospective analysis, older patients with BTC are less likely to undergo an intervention. However, active therapy when given is associated with similar survival benefits, irrespective of age.
authors.affiliation: Princess Margaret Cancer Centre, Department of Medical Oncology, Toronto, ON, Canada.|Present address: University Hospital Waterford, Department of Medical Oncology, Ardkeen, Waterford, Ireland.
authors.forename: Anne
authors.initials: A
authors.lastname: Horgan
authors.affiliation: Princess Margaret Cancer Centre, Department of Medical Oncology, Toronto, ON, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Knox
authors.affiliation: Princess Margaret Cancer Centre, Department of Medical Oncology, Toronto, ON, Canada.
authors.forename: Priya
authors.initials: P
authors.lastname: Aneja
authors.affiliation: Princess Margaret Cancer Centre, Department of Biostatistics, Toronto, ON, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Le
authors.affiliation: Princess Margaret Cancer Centre, Department of Medical Oncology, Toronto, ON, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McKeever
authors.affiliation: Princess Margaret Cancer Centre, Department of Medical Oncology, Toronto, ON, Canada.|Present address: The Christie NHS Foundation Trust/University of Manchester, Institute of Cancer Sciences, Manchester, UK.
authors.forename: Mairead
authors.initials: M
authors.lastname: McNamara
mesh_terms: D000367:Age Factors; D000368:Aged; D001661:Biliary Tract Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D005260:Female; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D009864:Ontario; D010043:Outcome and Process Assessment, Health Care / Q000639:trends*; D010166:Palliative Care / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: biliary tract cancer; elderly; treatment