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Is rectal cancer appropriately managed in old age?

A new study suggests that older patients undergoing treatment for rectal cancer have comparable outcomes to their younger counterparts. However, older people were less likely to receive potentially curative treatments than their younger counterparts, and this variation is not fully explained by differences in the distribution of important prognostic factors related to age.

Researchers used the CORECT-R (COloRECTal cancer data Repository) to obtain patient data, tumour and treatment characteristics for all patients diagnosed with a first primary rectal cancer in England between 2009 and 2014 and assessed the use of radical rectal cancer treatments and associated outcomes in relation to age across the English National Health Service (NHS).

Overall, 30,134 patients (56.9%) received a major surgical resection and the proportion undergoing a major resection fell from 66.5 to 31.7% amongst those aged <70 to ≥80 years of age, respectively. After adjustment, the odds of 30-day post-operative mortality (70-79 years: OR, 2.88; 95% CI, 2.36-3.52 and ≥80 years: OR, 5.08; 95% CI, 4.08-6.32), failure to rescue (70-79 years: OR, 2.29; 95% CI, 1.61-3.26 and ≥80 years: OR, 3.78; 95% CI, 2.47-5.77), prolonged length of stay and the presence of a stoma at 18 months from creation were significantly higher among the oldest group when compared with the youngest patients.

Compared with patients aged <70 years, the odds of high levels of social distress were lower amongst individuals aged 70-79 years (OR, 0.47; 95% CI, 0.39-0.57) or ≥80 years (OR, 0.59; 95% CI, 0.43-0.80). Patient-reported outcomes were not significantly worse amongst older patients. Substantial variation in the use of major resection amongst the oldest patients was observed between NHS Trusts in England (rates ranging from 9.7 to 54.2%). Despite the probability of death increasing with age because of other causes, the probability of death because of cancer was comparable between age groups in both treatment categories (major resection and no major resection).

“Our data should help both patients and the multidisciplinary teams who manage them to make informed decisions about treatment. For example, when surgeons discuss treatment options with older patients with rectal cancer they can refer to this very large ‘real world’ study of the results achieved in the English NHS when they are considering the role of radical surgery to inform patients of the risks and benefits of treatment,” the authors said.


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