title: Management of stage III colon cancer in the elderly: Practice patterns and outcomes in the general population.
abstract: BACKGROUND
  Clinical trials have established surgical resection and adjuvant chemotherapy (ACT) as the standard management for stage III colon cancer; however, the extent to which these results apply to elderly patients in routine practice is unclear. This article describes the management and outcomes of elderly patients with stage III colon cancer.
  
  
  METHODS
  All cases of surgically resected colon cancer from 2002 to 2008 were identified with the population-based Ontario Cancer Registry. Pathology reports were obtained for a random sample (25% of all cases); those with stage III disease constituted the study population. The utilization of ACT, cancer-specific survival (CSS), and overall survival (OS) in elderly patients (≥70 years) and nonelderly patients (<70 years) were compared.
  
  
  RESULTS
  The study population included 2920 patients, and 1521 (52%) were elderly. The 30- and 90-day mortality rates increased with advanced age: <70 years, 2% and 5%; 70 to 74 years, 3% and 7%; 75 to 79 years, 5% and 8%, and ≥80 years, 9% and 16% (P < .001). ACT was delivered to 48% of elderly patients and to 81% of younger patients (P < .001). Factors independently associated with ACT utilization among the elderly were a younger age (P < .001), male sex (P = .041), and no comorbidities (P = .001). Among elderly patients, ACT was associated with improved CSS (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.60-0.88) and OS (HR, 0.71; 95% CI, 0.60-0.83); however, the magnitude of the benefit was smaller for elderly patients than younger patients (HR for CSS, 0.53; 95% CI, 0.42-0.67; HR for OS 0.56; 95% CI, 0.45-0.69).
  
  
  CONCLUSIONS
  Half of elderly patients with stage III colon cancer do not receive ACT. Although the effect size is smaller than that in younger patients, ACT is associated with improved long-term survival. Cancer 2017;123:2840-49. © 2017 American Cancer Society.
authors.affiliation: Department of Oncology, Queen's University, Kingston, Ontario, Canada.|Department of Surgery, Queen's University, Kingston, Ontario, Canada.
authors.forename: Shaila J
authors.identifier: http://orcid.org/0000-0002-8133-7988
authors.initials: SJ
authors.lastname: Merchant
authors.affiliation: Department of Oncology, Queen's University, Kingston, Ontario, Canada.|Department of Surgery, Queen's University, Kingston, Ontario, Canada.
authors.forename: Sulaiman
authors.initials: S
authors.lastname: Nanji
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.
authors.forename: Kelly
authors.initials: K
authors.lastname: Brennan
authors.affiliation: Department of Oncology, Queen's University, Kingston, Ontario, Canada.|Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.
authors.forename: Safiya
authors.initials: S
authors.lastname: Karim
authors.affiliation: Department of Oncology, Queen's University, Kingston, Ontario, Canada.|Department of Surgery, Queen's University, Kingston, Ontario, Canada.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Patel
authors.affiliation: Department of Oncology, Queen's University, Kingston, Ontario, Canada.
authors.forename: James J
authors.initials: JJ
authors.lastname: Biagi
authors.affiliation: Department of Oncology, Queen's University, Kingston, Ontario, Canada.|Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Booth
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D003110:Colonic Neoplasms / Q000473:pathology / Q000628:therapy*; D015897:Comorbidity; D013505:Digestive System Surgical Procedures; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009864:Ontario; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012042:Registries; D012737:Sex Factors; D016896:Treatment Outcome
keywords: chemotherapy; colon cancer; elderly; outcomes; surgery