Introduction In the UK population those aged over 85 will almost double by 2037. An ageing population, rising bowel cancer and recognition that chronological age is no longer a barrier to individualised treatment, renders colorectal cancer (CRC) in this age-group increasingly important. We report the outcomes for patients over 85 diagnosed with CRC in our institution. The aim was to appraise treatment choices and outcomes in order to inform decision making for patients in this age group.
Method We reviewed all patients from 2008–10 discussed in colorectal MDT >85 years old with proven colorectal adenocarcinoma. Data was collected from electronic notes, GP and public records. Patients were assigned to 3 treatment arms; curative surgery (CS), other treatments (OT) and best supportive care (BSC). OT group included chemotherapy, radiotherapy, local or endoscopic excision and stents.
Results 105 patients (64 female) were included in this study. 42 had CS (7 laparoscopic), 36 OT and 27 BSC. Treated groups (CS and OT) were similar in age (p = 0.35) and staging (p = 0.16) while the BSC group were significantly older with higher stage disease (p < 0.01). 13 (31%) had emergency surgery in the CS group.
Survival was significantly poorer in BSC than those who are treated, mean 9.7 months (95% CI 4.7–14.7) vs. 41.6 months (95% CI 32.5–50.7) for CS and 27.3 months (95% CI 20.4–34.1) for OT (p < 0.001). Interesting, within years 1–2, whether treated with CS or OT both groups had similar survival (p = 0.12), 53% for both. CS had higher 90 day mortality 12% (n = 6) vs. 3% OT (n = 1). However, after 2 years the group who had OT move toward a very similar 5 year survival to the BSC group (p < 0.001), survival declining to 13% vs. 43% in CS by 5 years.
Right sided tumours dominated CS (p < 0.01) and in survival analysis by site, right sided tumours appeared to have a better survival, although not significant (p = 0.227). Rectal tumours formed the majority that were treated with OT (p < 0.01) and had significantly better survival than those treated with CS (p < 0.01).
Conclusion Our study highlights that despite what is regarded curative treatment for CRC there appears to be no difference in survival over the first 2 years compared to other treatments. However, beyond 2 years a clear survival benefit is apparent. This is important when treating patients at the extremes of age who are the most likely to ask ‘what happens if I don’t have a big operation?’ and indeed, it is a duty of informed consent to talk about alternatives.
Our results also suggest that the site of the cancer may matter. Right-sided cancers were more likely to be treated with CS. Rectal tumours were more likely to receive other treatment. Does this reflect our intuitive understanding of outcomes and risks in over 85 years old or are we prejudice?
Disclosure of interest None Declared.
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