Incidence and Predictors of Bowel Obstruction in Elderly Patients With Stage IV Colon Cancer

Obturator hernia is rare, but it must be considered in elderly patients who present with small bowel obstruction. The diagnosis is challenging unless there is a high index of suspicion as the presenting symptoms and signs are usually non-specific. Presence of positive Howship-Romberg sign is considered pathognomonic. Early diagnosis and rapid surgical intervention will reduce the high morbidity and mortality associated with undiagnosed obturator hernia. We report a case of a 93-year-old female patient who was admitted to our surgical department with symptoms of intestinal obstruction of 3-days duration. Howship-Romberg sign was negative. Computed tomography (CT) demonstrated the presence of left obturator hernia with proximal small bowel obstruction and no sign of strangulation. The patient had emergency laparotomy post-CT where the incarcerated bowel loop was released and the obstructed bowel was decompressed without any complication. The hernial defect was close with a mesh and the patient had an uneventful recovery post-surgery. In this case, we highlight that diagnosis of obturator hernia must always be considered in elderly patients who present with intestinal obstruction. Urgent CT could establish a rapid pre-operative diagnosis and aids inappropriate surgical intervention planning which is crucial in optimising the outcome.

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Decreasing Use of Chemotherapy in Older Patients With Stage III Colon Cancer Irrespective of Comorbidities

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2019.7287 ◽

2019 ◽

Vol 17 (9) ◽

pp. 1089-1099 ◽

Cited By ~ 6

Author(s):

Viola Walter ◽

Daniel Boakye ◽

Janick Weberpals ◽

Lina Jansen ◽

Walter E. Haefeli ◽

...

Keyword(s):

Colon Cancer ◽

Elderly Patients ◽

Old Age ◽

Population Based ◽

Stage Iii ◽

Stage Iii Colon Cancer ◽

Patient Interviews ◽

Chemotherapy Administration ◽

Hospital Factors ◽

Chemotherapeutic Treatment

Background: Chemotherapy underuse in elderly patients (aged ≥75 years) with colon cancer has been reported in previous studies. However, these studies were mostly registry-based and limited in their potential to consider underlying reasons of such undertreatment. This study aimed to evaluate patient and hospital determinants of chemotherapeutic treatment in patients with stage III colon cancer, with a particular focus on age and underlying reasons for nontreatment of elderly patients. Methods: A total of 629 patients with stage III colon cancer who were diagnosed in 2003 through 2012 and recruited into a population-based study in the Rhine-Neckar region of Germany were included. Information on sociodemographic and lifestyle factors, comorbidities, and treatment was collected from patient interviews and physicians. Patient (with an emphasis on age) and hospital factors were evaluated for their associations with administration of adjuvant chemotherapy overall and of oxaliplatin specifically using multivariable logistic regression. Results: Administration of chemotherapy decreased from 94% in patients aged 30 to 64 years to 51% in those aged ≥75 years. A very strong decline in chemotherapy use with age persisted even after comprehensive adjustment for multiple patient factors—including comorbidities—and hospital factors and was also seen among patients without any major comorbidities. Between 2005 and 2008, and 2009 and 2012, chemotherapy administration in patients aged ≥75 years decreased from 60% to 41%. Among chemotherapy recipients, old age was also strongly associated with higher odds of nonadministration of oxaliplatin. The 2 most commonly reported reasons for chemotherapy nonreceipt among the study population were patient refusal (30%) and old age (24%). Conclusions: Age was the strongest predictor of chemotherapy underuse, irrespective of comorbidities and even in patients without comorbidities. Such underuse due just to older age in otherwise healthy patients deserves increased attention in clinical practice to ensure that elderly patients also get the best possible care. Patients’ refusal as the most frequent reason for chemotherapy nonreceipt also warrants further investigation to exclude misinformation as underlying cause.

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