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Title

Impact of age on the use of adjuvant treatments in patients undergoing surgery for colorectal cancer: patients with stage III colon or stage II/III rectal cancer

AuthorsSarasqueta, Cristina; Perales, A.; Escobar, Antonio; Baré, María Luisa; Redondo, Maximino; Fernández de Larrea, Nerea; Briones, Eduardo; Piera, J. M.; Zunzunegui, M. V.; Quintana, José María
KeywordsColorectal cancer
Chemotherapy
Adherence
Equity
Preoperative radiotherapy
Age
Issue Date2019
PublisherBioMed Central
CitationBMC Cancer 19: 735 (2019)
Abstract[Background]: Many older patients don’t receive appropriate oncological treatment. Our aim was to analyse whether there are age differences in the use of adjuvant chemotherapy and preoperative radiotherapy in patients with colorectal cancer.
[Methods]: A prospective cohort study was conducted in 22 hospitals including 1157 patients with stage III colon or stage II/III rectal cancer who underwent surgery. Primary outcomes were the use of adjuvant chemotherapy for stage III colon cancer and preoperative radiotherapy for stage II/III rectal cancer. Generalised estimating equations were used to adjust for education, living arrangements, area deprivation, comorbidity and clinical tumour characteristics.
[Results]: In colon cancer 92% of patients aged under 65 years, 77% of those aged 65 to 80 years and 27% of those aged over 80 years received adjuvant chemotherapy (χ2trends < 0.001). In rectal cancer preoperative radiotherapy was used in 68% of patients aged under 65 years, 60% of those aged 65 to 80 years, and 42% of those aged over 80 years (χ2trends < 0.001). Adjusting by comorbidity level, tumour characteristics and socioeconomic level, the odds ratio of use of chemotherapy compared with those under age 65, was 0.3 (0.1–0.6) and 0.04 (0.02–0.09) for those aged 65 to 80 and those aged over 80, respectively; similarly, the odds ratio of use of preoperative radiotherapy was 0.9 (0.6–1.4) and 0.5 (0.3–0.8) compared with those under 65 years of age.
[Conclusions]: The probability of older patients with colorectal cancer receiving adjuvant chemotherapy and preoperative radiotherapy is lower than that of younger patients; many of them are not receiving the treatments recommended by clinical practice guidelines. Differences in comorbidity, tumour characteristics, curative resection, and socioeconomic factors do not explain this lower probability of treatment. Research is needed to identify the role of physical and cognitive functional status, doctors’ attitudes, and preferences of patients and their relatives, in the use of adjuvant therapies.
DescriptionConsortia: The REDISECC-CARESS/CCR group: Jose María Quintana, Marisa Baré, Maximino Redondo, Eduardo Briones Pérez de la Briones, Nerea Fernández de Larrea, Cristina Sarasqueta, Antonio Escobar , Francisco Rivas, Maria Morales-Suárez, Juan Antonio Blasco, Isabel del Cura , Inmaculada Arostegui, Amaia Bilbao, Nerea González , Susana García-Gutiérrez, Iratxe Lafuente, Urko Aguirre, Miren Orive, Josune Martin, Ane Antón-Ladislao, Núria Torà, Marina Pont, María Purificación Martínez del, Alberto Loizate, Ignacio Zabalza, José Errasti, Antonio Gimeno, Santiago Lázaro, Mercè Comas, Jose María Enríquez-Navascues, Carlos Placer, Amaia Perales, Iñaki Urkidi, Jose María Erro, Enrique Cormenzana, Adelaida Lacasta, Pep Piera, Elena Campano, Ana Isabel Sotelo, Segundo Gómez-Abril, F. Medina-Cano, Julia Alcaide, Arturo Del Rey-Moreno, Manuel Jesús Alcántara, Rafael Campo, Alex Casalots, Carles Pericay, Maria José Gil, Miquel Pera, Pablo Collera, Josep Alfons Espinàs, Mercedes Martínez, Mireia Espallargues, Caridad Almazán, Paula Dujovne, José María Fernández-Cebrián, Rocío Anula, Julio Mayol, Ramón Cantero, Héctor Guadalajara, María Alexandra Heras, Damián García, Mariel Morey & Alberto Colina.
Publisher version (URL)https://doi.org/10.1186/s12885-019-5910-z
URIhttp://hdl.handle.net/10261/212406
DOIhttp://dx.doi.org/10.1186/s12885-019-5910-z
E-ISSN1471-2407
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