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Surgical treatment of colon cancer in patients aged 80 years and older †
Analysis of 31,574 patients in the SEER-Medicare database
Article first published online: 14 AUG 2012
Copyright © 2012 American Cancer Society
Volume 119, Issue 3, pages 639–647, 1 February 2013
How to Cite
Neuman, H. B., O'Connor, E. S., Weiss, J., LoConte, N. K., Greenblatt, D. Y., Greenberg, C. C. and Smith, M. A. (2013), Surgical treatment of colon cancer in patients aged 80 years and older . Cancer, 119: 639–647. doi: 10.1002/cncr.27765
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.
Fax: (608) 263-7652
- Issue published online: 22 JAN 2013
- Article first published online: 14 AUG 2012
- Manuscript Accepted: 10 JUL 2012
- Manuscript Revised: 20 JUN 2012
- Manuscript Received: 24 APR 2012
- colon cancer;
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.
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.
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%).
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.