Colorectal cancer in the elderly and the influence of lead time bias: better survival does not equate with improved life expectancy

Aims Poorer outcomes in those aged ≥80 years who undergo colorectal cancer surgery have been previously reported. Little is known about the natural history of those managed non-operatively. We explored outcomes in all patients with colorectal cancer aged ≥80 years at time of diagnosis based on treat...

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Published in:	International journal of colorectal disease 2016-03, Vol.31 (3), p.553-559
Main Authors:	Knight, Katrina, Oliphant, Raymond, Maxwell, Fraser, McKenzie, Claire, McCann, Maria, Hammill, Raymond, Sharma, Praveen, Macdonald, Angus
Format:	Article
Language:	eng
Subjects:	Aged Aged, 80 and over Analysis Cancer patients Censorship Colorectal cancer Colorectal Neoplasms - diagnosis Colorectal Neoplasms - epidemiology Colorectal Neoplasms - mortality Coronary artery bypass Endoscopy Female Gastroenterology Hepatology Humans Internal Medicine Kaplan-Meier Estimate Life Expectancy Male Medicine Medicine & Public Health Mortality Original Article Patient outcomes Proctology Proportional Hazards Models Surgery Time Factors
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Summary:	Aims Poorer outcomes in those aged ≥80 years who undergo colorectal cancer surgery have been previously reported. Little is known about the natural history of those managed non-operatively. We explored outcomes in all patients with colorectal cancer aged ≥80 years at time of diagnosis based on treatment received. Methods Patients ≥80 years diagnosed with colorectal cancer in one hospital trust between 1998 and 2011 were identified from a prospectively maintained database. Primary endpoints were age at diagnosis, age at death/censor and mortality at 30, 90 and 365 days. Results Six hundred sixty-eight patients were identified. Four hundred twelve (61.7 %) underwent surgery, 44 (6.6 %) received endoscopic therapy and 212 (31.7 %) had no active treatment. Of those who underwent surgery, 359 (87.1 %) had resectional surgery, 34 (8.3 %) defunctioning only, 13 (3.2 %) received bypass surgery and 6 (1.5 %) had an open and close laparotomy. The mean age at diagnosis was younger in those who underwent surgical resection (83.7 years) compared to those having defunctioning surgery (84.9 years, P = 0.043), endoscopic therapy (85.1 years, P = 0.008) or no surgical intervention (85.6 years, P
ISSN:	0179-1958 1432-1262