Surgical treatment of colon cancer in patients aged 80 years and older

Analysis of 31,574 patients in the SEER-Medicare database

Authors

  • Heather B. Neuman MD,

    Corresponding author
    1. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
    • Department of Surgery, University of Wisconsin School of Medicine and Public Health, Clinical Science Center H4/726, 600 Highland Ave, Madison, WI 53792-7375

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    • Fax: (608) 263-7652

  • Erin S. O'Connor MD,

    1. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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  • Jennifer Weiss MD,

    1. Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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  • Noelle K. LoConte MD,

    1. Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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  • David Y. Greenblatt MD,

    1. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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  • Caprice C. Greenberg MD,

    1. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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  • Maureen A. Smith MD

    1. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
    2. Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
    3. Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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  • The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred.

Abstract

BACKGROUND:

Age-related disparities in colon cancer treatment exist, with older patients being less likely to receive recommended therapy. However, to the authors' knowledge, few studies to date have focused on receipt of surgery. The objective of the current study was to describe patterns of surgery in patients aged ≥ 80 years with colon cancer and examine outcomes with and without colectomy.

METHODS:

Medicare beneficiaries aged ≥ 80 years with colon cancer who were diagnosed between 1992 and 2005 were identified from the Surveillance, Epidemiology, and End Results-Medicare database. Multivariable logistic regression analysis was used to assess factors associated with nonoperative management. Kaplan-Meier survival analysis determined 1-year overall and colon cancer-specific survival.

RESULTS:

Of 31,574 patients, 80% underwent colectomy. Approximately 46% were diagnosed during an urgent/emergent hospital admission, with decreased 1-year overall survival (70% vs 86% for patients diagnosed during an elective admission) noted among these individuals. Factors found to be most predictive of nonoperative management included older age, black race, more hospital admissions, use of home oxygen, use of a wheelchair, being frail, and having dementia. For both operative and nonoperative patients, the 1-year overall survival rate was lower than the colon cancer-specific survival rate (operative patients: 78% vs 89%; nonoperative patients: 58% vs 78%).

CONCLUSIONS:

The majority of older patients with colon cancer undergo surgery, with improved outcomes noted compared with nonoperative management. However, many patients who are not selected for surgery die of unrelated causes, reflecting good surgical selection. Patients undergoing surgery during an urgent/emergent admission have an increased short-term mortality risk. Because the earlier detection of colon cancer may increase the percentage of older patients undergoing elective surgery, the findings of the current study may have policy implications for colon cancer screening and suggest that age should not be the only factor driving cancer screening recommendations. Cancer 2013. © 2012 American Cancer Society.

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