Evaluation of outcomes in elderly patients diagnosed with colorectal cancer

Background: Colorectal cancer in the elderly carries a high morbidity and mortality. The National Bowel Cancer Audit Programme is a high-quality audit incorporating all UK colorectal cancer patients. Author analysed this database to investigate the local outcomes for this high-risk group.Methods: Data (mode of presentation, presence of metastatic disease, treatment surgery, colonic stent or conservative and WHO performance status) was collected on all patients aged 85 years or over diagnosed with colorectal cancer at a large tertiary referral centre over a 5-year period. Ninety day and 2 year-mortality was obtained for all patients.Results: Ninety patients (45 male, 45 female, median age 88.9 range 85.0-97.9 years) were included (47 emergency presentation, 43 elective presentation). A 18 of 47 patients underwent emergency surgery. A 90-day and 2-year mortality in this group was 17% and 69% respectively. 29 of 47 patients presenting as an emergency had non-operative treatment (2-year mortality 87%). Two years mortality for patients undergoing emergency surgery was 100% if aged above 90 years or if distant metastases were present. Eleven of 43 patients presenting electively underwent surgery. 90-day and 2-year mortality for this group was 18% and 0% respectively. Two years mortality for those presenting electively and undergoing non-operative treatment was 62%.Conclusions: Decision making must be very carefully considered in patients aged over 85 years as the presence of metastases, poor WHO performance status or age over 90 carries with it a significant risk of mortality at both 90 days and 2 years following diagnosis.

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Clinical and pathological characteristics of elderly colorectal cancer patients over 70 years old and comparison with patients under 50 years old.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14174 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14174-e14174

Author(s):

Betul Erismis ◽

Nadire Kucukoztas ◽

Samed Rahatli ◽

Selim Yalcin ◽

Omer Dizdar ◽

...

Keyword(s):

Colorectal Cancer ◽

Elderly Patients ◽

Cancer Patients ◽

Systemic Disease ◽

Performance Status ◽

The Elderly ◽

University Hospital ◽

Individual Treatment ◽

Pathological Characteristics ◽

Colorectal Cancer Patients

e14174 Background: Incidence of colon cancer increases with age and generally is diagnosed at the age of between 60-75. Because of comorbidities in elderly patients who are older 70 years of age, lower doses of adjuvant or metastatic therapy is given them or the other option can be the chemotherapeutics which had less side effects. Methods: We aim to identify clinical and pathological characteristics of elderly colorectal cancer patients over 70 years of age who were followed at Baskent University Hospital and compare with CRC patients under the 50 years of age. Results: 182 CRC patients were assigned to the study who were followed between 1998-2011. We classified the patients into two categories according to the age. 91 participants were over 70 years of age and 91 participants were under 50 years of age. There were no significant differences between two groups for gender and percentage of patients having surgery (p=0.65/0.732). History of having systemic disease was significantly higher in the elderly group (p<0.001). Adjvuvant chemotherapy was given to the 38 (53.5%) patients aged over 70 and 66 (91.7%) patients aged under 50 (p<0.001). We compared the both groups for progression free and overall survival time for all stages. However, there were no statistically significant differences between two groups. Conclusions: Our study confirms that elderly CRC patients get benefit from the adjuvant chemotherapy treatment as the same as patients under 50 years of age. Therefore, physcians should consider about performance status and systemic disease in elderly patients and give an individual treatment to them.

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Adjuvant or Palliative Chemotherapy for Colorectal Cancer in Patients 70 Years or Older

Journal of Clinical Oncology ◽

10.1200/jco.1999.17.8.2412 ◽

1999 ◽

Vol 17 (8) ◽

pp. 2412-2412 ◽

Cited By ~ 193

Author(s):

R. A. Popescu ◽

A. Norman ◽

P. J. Ross ◽

B. Parikh ◽

D. Cunningham

Keyword(s):

Colorectal Cancer ◽

Elderly Patients ◽

Older Patients ◽

Palliative Chemotherapy ◽

Performance Status ◽

Age Groups ◽

Response Rates ◽

The Elderly ◽

Younger Patients ◽

Royal Marsden Hospital

PURPOSE: The surgical treatment of colorectal cancer (CRC) in elderly patients (age 70 years or older) has improved, but data on adjuvant and palliative chemotherapy tolerability and benefits in this growing population remain scarce. Elderly patients are underrepresented in clinical trials, and results for older patients are seldom reported separately. PATIENTS AND METHODS: Using a prospective database, we analyzed demographics, chemotherapy toxicity, response rates, failure-free survival (FFS), and overall survival (OS) of CRC patients receiving chemotherapy at the Royal Marsden Hospital. The cutoff age was 70 years. RESULTS: A total of 844 patients received first-line chemotherapy with various fluorouracil (5-FU)-containing regimens or raltitrexed for advanced disease, and 543 patients were administered adjuvant, protracted venous infusion 5-FU or bolus 5-FU/folinic acid (FA) chemotherapy. Of the 1,387 patients, 310 were 70 years or older. There was no difference in overall or severe (Common Toxicity Criteria III to IV) toxicity between the two age groups, with the exception of more frequent severe mucositis in older patients receiving adjuvant bolus 5-FU/FA. For patients receiving palliative chemotherapy, no difference in response rates (24% v 29%, P = .19) and median FFS (164 v 168 days) were detected when the elderly were compared with younger patients. Median OS was 292 days for the elderly group and 350 days for the younger patients (P = .04), and 1-year survival was 44% and 48%, respectively. The length of inpatient hospital stay was identical. CONCLUSION: Elderly patients with good performance status tolerated adjuvant and palliative chemotherapy for CRC as well as did younger patients and had similar benefits from palliative chemotherapy.

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A systematic review of end of life cancer care in the elderly population in Qatar: A retrospective cohort study.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.87 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 87-87

Author(s):

Azza Adel Hassan ◽

Ayman Allam ◽

Cicy Mary Jacob

Keyword(s):

Colorectal Cancer ◽

Cohort Study ◽

End Of Life ◽

Elderly Population ◽

Performance Status ◽

Age Groups ◽

The Elderly ◽

Place Of Death ◽

Common Diagnosis ◽

Eol Care

87 Background: Managing cancer in the elderly ( ≥ 65 years of age) is quite challenging as a result of associated comorbidities, poor performance status and the expected lower tolerance to treatment. The aim of the present study is to report on the demographics of cancer in the elderly population at NCCCR, also to analyze different indicators constituting End of Life (EoL) care in this subgroup of patients. Methods: Elderly patients ( ≥ 65 years of age) presenting with cancer diagnosis to NCCCR between January 01, 2009 till December 31, 2013 constituted the cohort study group. Their medical records were reviewed for the following items: Diagnosis, Performance status, age, comorbidities, treatment received, place of death, Length of Stay (LOS) during last hospitalizations as well as aggressiveness of care at EoL. Patients were then subdivided into 3 age groups: 65-74 years (n = 175), 75-79 years (n = 63) and ≥ 80 years (n = 54). Results: The most common diagnosis was colorectal cancer (42%, 35% and 46% in the 3 age groups respectively). The palliative ward was the most common place of death (43%, 46% and 36% respectively) followed by Medical ICU (26%, 14% and 20% respectively). The median survival from the date of admission in last hospitalization was not different in the 3 age groups (9.4 days vs 9.11 days vs 8.8 days respectively). There was no statisticallly significant differences between the 3 age groups as regards any of the 6 indicators of aggressive care. However, a high percentage of ICU admissions (ranging between 20% - 29%) was reported across all age groups. Conclusions: Colorectal cancer is the most common type of cancer in elderly population in Qatar. Admission to ICU in the last month of life was high, ranging between 20-29%. The mean LOS of last hospitalization was short ranging between 8.8 - 9.4 days. These findings would warrant the development of a needed community palliative care service that would allow this group of patients to receive their EOL care at home, rather than in hospital.

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Bevacizumab in the first-line treatment of elderly patients with metastatic colorectal cancer: Mature results from a large community-based observational study.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.566 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 566-566 ◽

Cited By ~ 1

Author(s):

Ralf Hofheinz ◽

Wilfried Grothe ◽

Dirk Tummes ◽

Manfred Kindler ◽

Volker Petersen ◽

...

Keyword(s):

Colorectal Cancer ◽

Observational Study ◽

Metastatic Colorectal Cancer ◽

Performance Status ◽

Progression Free Survival ◽

The Elderly ◽

Line Treatment ◽

First Line ◽

Eligibility Criteria ◽

Organ Site

566 Background: In most patients (pts) with metastatic colorectal cancer, a 3-drug combination of a fluoropyrimidine, oxaliplatin (ox) or irinotecan (iri), and a monoclonal antibody is considered standard 1st-line treatment. However, in elderly pts this choice remains controversial. After registration of bevacizumab (bev) in Germany in 2005, this observational study was initiated in pts receiving bev with various first-line chemotherapy (CT) regimens to evaluate the disease profile and efficacy of bev in patients with metastatic colorectal cancer. Methods: Eligibility criteria focused on M1 disease without prior palliative CT. The choice of CT regimen was at the physician’s discretion. Predefined efficacy endpoints were: response rate (RR), progression-free survival (PFS) and overall survival (OS). Pts were followed for up to 6 years (y). Two pt subgroups were analyzed: ≥70 y and ≥75 y; the ≥75 y group is the focus of this abstract. Results: 1777 eligible pts were enrolled at 261 sites from Jan 2005 to June 2009, 206 (12%) of whom were aged ≥75 y. These elderly pts did not differ greatly vs younger pts in time from initial diagnosis or time to first relapse, pT, pN and M stage, site of metastasis, grading, CEA, WBC, blood pressure, or prior adjuvant therapy. However, fewer elderly pts had >1 involved organ site (28% of pts ≥75 y vs. 32% of pts ≥70 y) and elderly pts had significantly poorer performance status (ECOG 0 in 29% of pts ≥75 y vs. 39% of pts ≥70 y). Bev treatment duration was similar in elderly and younger pts, but differences in CT usage were observed (Table). Response and survival outcomes were significantly worse in those aged ≥75 y. Conclusions: Bev-based treatment combinations can be used successfully in pts aged ≥75 y. However, PFS and OS are significantly shorter in pts aged ≥75 y vs younger pts, probably because of greater comorbidity and possibly because of less intensive treatment in the elderly. [Table: see text]

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Resection of colorectal cancer (CRC) metastases in routine practice.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.599 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 599-599

Author(s):

Ben Tran ◽

Hui-li Wong ◽

Kathryn Maree Field ◽

Jeanne Tie ◽

Jeremy David Shapiro ◽

...

Keyword(s):

Colorectal Cancer ◽

Performance Status ◽

Distant Metastases ◽

Public Hospitals ◽

Routine Practice ◽

Disease Site ◽

Multimodality Approach ◽

Treatment Intent ◽

Critical Intervention

599 Background: The optimal management of metastatic colorectal cancer (mCRC) involves a multimodality approach. Complete resection of limited metastatic disease is a critical, potentially curative intervention for a minority of patients (pts). Data on resection rates and outcomes in routine clinical practice are limited. Methods: Analysis of pts prospectively entered onto the TRACC (Treatment of Recurrent and Advanced Colorectal Cancer) database, a multisite Australian mCRC registry. Data collection commenced in July 2009 and is ongoing at 14 centres. Treatment intent was recorded at initial pt review as curative, potentially curative or palliative. Results: At median follow-up of 20.9 months, 213 (21%) of 1,012 pts have undergone metastasectomy, including 179 (84%) R0 resections. Liver (55.4%) and lung (20.2%) were the commonest resected disease sites. For 26 (12.2%) pts the initial treatment intent had been palliative. Pts who had metastases resected were younger (median age 63 vs. 70 years, p<0.0001), of better performance status (PS0-1: 97.7 vs. 75.5%, p<0.0001), had fewer comorbidities (Charlson Index ≤3: 75.1 vs. 55.9%, p<0.0001) and fewer sites of disease (single site: 79.8% vs. 52.5%, p<0.0001). A significantly higher proportion of pts treated in private than public hospitals underwent resections: 143/548 (26.1%) vs. 70/459 (15.3%), p<0.0001. At initial presentation, more private pts had PS0-1 (82.8% vs. 77.8%, p=0.0459) and single disease site (61.3% vs. 54.5%, p=0.0291) than public pts, but the median age of private pts was higher (70 vs. 67 years, p=0.041). Overall survival was equivalent for resected pts in both groups (median not reached, HR 0.96, 95% CI 0.45-2.06, p=0.9189). Conclusions: A substantial proportion of mCRC pts in routine practice undergo resection of distant metastases, including some pts initially considered incurable. Significant variation between sites has been noted, which may relate to differences in pt population and/or a more aggressive treatment approach. Multivariate analyses and review of individual centre data are planned to explore reasons for potential underutilization of this critical intervention.

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Pelvic exenteration for colorectal and non-colorectal cancer: a comparison of perioperative and oncological outcome

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03893-y ◽

2021 ◽

Author(s):

Andreas Bogner ◽

Johannes Fritzmann ◽

Benjamin Müssle ◽

Johannes Huber ◽

Jakob Dobroschke ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Survival Data ◽

Pelvic Exenteration ◽

Univariate Analysis ◽

Neoadjuvant Treatment ◽

Significant Risk ◽

R0 Resection ◽

High Morbidity ◽

Primary Tumors

Abstract Background Pelvic exenteration (PE) is the only option for long-term cure of advanced cancer originating from different types of tumor or recurrent disease in the lower pelvis. The aim was to show differences between colorectal and non-colorectal cancer in survival and postoperative morbidity. Methods Retrospective data of 63 patients treated with total pelvic exenteration between 2013 and 2018 are reported. Pre-, intra-, and postoperative parameters, survival data, and risk factors for complications were analyzed. Results A total of 57.2% (n = 37) of the patients had colorectal cancer, 22.3% had gynecological malignancies (vulvar (n = 6) or cervical (n = 8) cancer), 11.1% (n = 7) had anal cancer, and 9.5% had other primary tumors. A total of 30.2% (n = 19) underwent PE for a primary tumor and 69.8% (n = 44) for recurrent cancer. The 30-day in-hospital mortality was 0%. Neoadjuvant treatment was administered to 65.1% (n = 41) of the patients and correlated significantly with postoperative complications (odds ratio 4.441; 95% CI: 1.375–14.342, P > 0.05). R0, R1, R2, and Rx resections were achieved in 65.1%, 19%, 1.6%, and 14.3% of the patients, respectively. In patients undergoing R0 resection, 2-year OS and RFS were 73.2% and 52.4%, respectively. Resection status was a significant risk factor for recurrence-free and overall survival (OS) in univariate analysis. Multivariate analysis revealed age (P = 0.021), ASA ≥ 3 (P = 0.005), high blood loss (P = 0.028), low preoperative hemoglobin level (P < 0.001), nodal positivity (P < 0.001), and surgical complications (P = 0.003) as independent risk factors for OS. Conclusion Pelvic exenteration is a procedure with high morbidity rates but remains the only curative option for advanced or recurrent colorectal and non-colorectal cancer in the pelvis.

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Colorectal Cancer in Northern Tanzania: Increasing Trends and Late Presentation Present Major Challenges

JCO Global Oncology ◽

10.1200/jgo.19.00301 ◽

2020 ◽

pp. 375-381

Author(s):

Ayesiga M. Herman ◽

Alexander T. Hawkins ◽

Kennedy Misso ◽

Christian Issangya ◽

Murad Tarmohamed ◽

...

Keyword(s):

Colorectal Cancer ◽

Age Groups ◽

Fold Increase ◽

Tertiary Hospital ◽

Late Presentation ◽

High Morbidity ◽

Emergency Presentation ◽

Northern Tanzania ◽

Clinical Records ◽

Study Participants

PURPOSE A trend of increasing incidence of colorectal cancer (CRC) has been observed in northern Tanzania. Studies have shown a six-fold increase in CRC in the past decade, with 90% of patients presenting in late stages, with resultant high morbidity and mortality rates. In this study, we aimed to document the burden of CRC in the northern zone of Tanzania from 1998 to 2018, focusing on patient presentation, clinical features, and treatment at a tertiary hospital. METHODS Pathological and clinical records for all patients from 1998 to 2018 were identified and reviewed. Records of patients whose CRC was diagnosed histologically were retrospectively reviewed. RESULTS Approximately 313 CRC cases were documented. The majority age group (29.1%) was between 50 and 64 years (mean [standard deviation], 54.28 [16.75] years). However, together, the age groups of patients younger than 50 years was 41.5% (n = 130). Of 174 patients with complete records, most (29.3%) were between 35 and 49 years of age. The median age was 52 (interquartile range, 40-67) years. Men accounted for 62.1% of patients and were mostly from the Kilimanjaro region. More than half (54.7%) presented > 3 months after symptom debut; 62.6% first sought care at lower-level health facilities. Most (64.9%) presented as emergencies, necessitating colostomy for fecal diversion as the initial surgical procedure in 60.3% of patients. Colonoscopy was performed for 38.6% of the study participants. Most tumors (72.7%) originated from the sigmoid and rectum. Adenocarcinoma was the most prevalent histologic type. CONCLUSION High proportions of young individuals with CRC pose great concern and a need for further appraisal. Furthermore, late emergency presentation and low colonoscopy rates highlights underlying system challenges and need for education campaigns.

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Primary Tumour Resection Could Improve the Survival of Unresectable Metastatic Colorectal Cancer Patients Receiving Bevacizumab-Containing Chemotherapy

Cellular Physiology and Biochemistry ◽

10.1159/000447829 ◽

2016 ◽

Vol 39 (3) ◽

pp. 1239-1246 ◽

Cited By ~ 8

Author(s):

Zhiming Wang ◽

Li Liang ◽

Yiyi Yu ◽

Yan Wang ◽

Rongyuan Zhuang ◽

...

Keyword(s):

Colorectal Cancer ◽

Radiation Therapy ◽

Combination Chemotherapy ◽

Systemic Therapy ◽

Emergency Surgery ◽

Primary Tumour ◽

Performance Status ◽

Tumour Resection ◽

Clinical Events ◽

Primary Tumour Resection

Background: The effect of primary tumour resection (PTR) among metastatic colorectal cancer (mCRC) patients remains controversial. Combination chemotherapy with bevacizumab could improve the clinical outcomes of these patients, which might change the importance of PTR in the multi-disciplinary treatment pattern. Methods: We performed a non-randomized prospective controlled study of mCRC pts whose performance status (PS) scored ≤2 and who received bevacizumab combination chemotherapy (FOLFOX/XELOX/FOLFIRI) as a first-line therapy. These patients were classified into the PTR group and the IPT (intact primary tumour) group according to whether they underwent PTR before receiving the systemic therapy. The progression free survival (PFS) time and overall survival (OS) time, which were recorded from the start of the primary diagnosis until disease progression and death or last follow-up, were analysed. We also compared severe clinical events (such as emergency surgery, radiation therapy, and stent plantation) between the two groups. Results: One hundred and nighty-one mCRC pts (108 male patients and 93 female patients) were entered in this prospective observational study. The median age was 57.5 years old. The clinical characteristics (age, gender, performance status, primary tumour site, RAS status, and the number of metastatic organs) did not significantly differ between the two groups. The median PFS and OS times of the PTR group were superior than those of the IPT group (10.0 vs 7.8 months, p < 0.01 and 22.5 vs 17.8 months, p < 0.01, respectively). The incidences of adverse events associated with systemic therapy were similar between the two groups. Specifically, sixteen patients (21.9%, 16/73) with IPT developed significant primary tumour-related complications, such as bleeding, obstruction or even perforation. Among these patients, five underwent emergency surgery, three patients received a stent, and eight patients underwent radiation therapy. Conclusions: The mCRC patients who received PTR and bevacizumab combination chemotherapy had better clinical outcomes than patients who did not receive PTR. PTR also decreased the incidence of severe clinical events and improved quality of life.

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Oxaliplatin associated neurotoxicity outcomes among older adults with colorectal cancer: A population-based study.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.601 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 601-601

Author(s):

Michael J. Raphael ◽

Hadas Fischer ◽

Kinwah Fung ◽

Peter Austin ◽

Christopher M. Booth ◽

...

Keyword(s):

Colorectal Cancer ◽

Neuropathic Pain ◽

Significant Risk ◽

The Elderly ◽

Population Based ◽

Pain Medication ◽

Stage Ii ◽

Administrative Databases ◽

Risk Of Death ◽

New Diagnosis

601 Background: The addition of oxaliplatin to fluorouracil-based regimens in the adjuvant treatment of colorectal cancer (CRC) has been shown to improve overall survival at the expense of increased toxicity. Toxicity may be higher among older patients who may also derive less benefit from oxaliplatin. The incidence of toxicity in the elderly is unknown. Methods: A cohort of patients ≥ 66 years old diagnosed with Stage II and III CRC between 2007 and 2011 in Ontario, Canada was identified using the Ontario Cancer Registry. Linked administrative databases were used to identify patients treated with oxaliplatin who were subsequently diagnosed with peripheral neuropathy (PN) or received a new prescription for a neuropathic pain medication. Patients were stratified into two age strata, ages 66-69 and ages ≥ 70, and each group was compared to a control cohort receiving non-oxaliplatin-based adjuvant chemotherapy (AC). Cause-specific hazard models were used to estimate the effect of Oxaliplatin exposure on the cause-specific hazard of PN and associated neurotoxicity outcomes after accounting for the competing risk of death. Results: We identified 3,607 patients aged ≥ 66 with Stage II and III CRC, of whom 1,541 were treated with an oxaliplatin-based AC regimen. Compared to control subjects receiving non-oxaliplatin based AC, patients ≥ 70 years old treated with oxaliplatin were more likely to be diagnosed with PN (cause-specific hazard ratio (CHR) age ≥ 70, 2.07 [95% CI, 1.43-3.00; p < 0.001]) and receive a new prescription for a neuropathic pain medication (CHR age ≥ 70, 1.86 [95% CI, 1.43-2.42;p < 0.001]). In patients aged 66-69, oxaliplatin use was not associated with a new diagnosis of PN (p = 0.903), but was associated with an increased likelihood of receiving a prescription for a neuropathic pain medication (CHR age 66-70, 1.92 [95% CI, 1.22-3.03; p = 0.005]). By the end of one year, the cumulative incidence of PN was 3.21% (95% CI, 2.02-4.81) for ages 66-69 and 5.51% (95% CI, 4.14-7.15) for age ≥ 70. Conclusions: In this population-based cohort of CRC patients ≥ 70 years old, treatment with oxaliplatin is associated with a significant risk of developing PN and requiring treatment with neuropathic pain medications.

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