br Contents lists available at ScienceDirect br Journal of
Contents lists available at ScienceDirect
Journal of Geriatric Oncology
Causes of mortality in older patients with stage 3 colon cancer
Tyler Raycraft a, Winson Y. Cheung b, Yaling Yin c, Caroline Speers c, Jenny J. Ko d, Caroline Mariano e,
a University of British Columbia, Vancouver, British Columbia, Canada
b University of Calgary, Department of Medical Oncology, Tom Baker Cancer Centre, Canada
c Division of Medical Oncology, BC Cancer, Abbotsford, British Columbia, Canada
d Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
e University of British Columbia, Royal Columbian Hospital, Department of Medicine, New Westminster, British Columbia, Canada
Objectives: Life expectancy plays a key role in the selection of patients with stage III colon cancer for adjuvant che-motherapy, but little is known about causes of mortality in older patients with colon cancer. We aimed to exam-ine causes of death in this Apomorphine and compare these causes between patients who received chemotherapy and those who did not. Specifically, we chose to examine the rates of death related to recurrent colon cancer ver-sus non colon cancer.
Materials and Methods: Patients aged 50 and older diagnosed with stage III colon cancer between 2005 and 2009 were included. Patients were divided into “younger” (aged 50–69) and “older” (aged 70+). Causes of death, which were categorized into colon cancer versus non-colon cancer related.
Results: 1361 patients were included, 50% of whom were 70 or older. Younger patients were more likely to re-ceive adjuvant chemotherapy (90% vs. 60%). 601 patients died in the follow up period. Deceased patients in the younger group were more likely to die from colon cancer (81% vs. 62%). The most common cause of non-colon cancer death was other primary malignancies in younger patients and cardiovascular diseases in older pa-tients. In older patients who received chemotherapy, 41% died; 89% of these deaths were related to colon cancer. In older patients who did not receive chemotherapy 72% died, with 38% of patients ultimately dying from colon cancer.
Conclusions: Older patients remain under-treated with chemotherapy. Although non-colon cancer deaths were more frequent in older patients with cancer, colon cancer was a still a significant cause of mortality. These deaths may be preventable with adjuvant chemotherapy.
Colorectal cancer (CRC) remains one of the most prevalent cancers worldwide and is often diagnosed in older individuals, with a median age of diagnosis at 71 years . Nearly 70% of all CRC diagnoses occur in individuals aged 65 years or older . Despite numerous studies showing improved survival with adjuvant chemotherapy following re-section in the general CRC population [2–4], older patients are consis-tently under-represented in clinical trials of chemotherapy, thus making it difficult to apply these data more broadly [5–7]. Existing evi-dence suggests that older patients may be under-treated [8–13]. Based on perceived frailty in older patients and their burden of co-morbidities, risk-benefit analyses of chemotherapy in older patients are challenging, thus posing difficulties in treatment decision-making.
Corresponding author at: Royal Columbian Hospital, Medical Oncology, 201-301 East Columbia Street, New Westminster, BC V3L3W5, Canada.
E-mail address: [email protected] (C. Mariano).
Expert opinion from geriatric oncology groups suggests that life ex-pectancy estimates play a key role in decisions regarding adjuvant ther-apy [10, 14]. The heterogeneity of life expectancy in this population and suboptimal understanding of normal physiology and pharmacokinetics in older patients can present barriers for clinicians. Several tools exist to help estimate life expectancy in older adults, driven primarily by patient co-morbidities and functional status [15–17]. However, they have not been specifically validated in the oncology population. Unfortunately, literature suggests that age alone may be a driving factor behind deci-sion-making in these patients, rather than a more robust functional as-sessment and consideration of life expectancy [9, 18]. Considering the expanding body of evidence that older patients derive comparable ben-efit from adjuvant chemotherapy as their younger counterparts [19– 21], age alone should not be considered a sufficient sole determinant of life expectancy. When assessing patients for adjuvant chemotherapy, ideally older patients with life expectancy of under 5 years should not be offered adjuvant therapy, while those with longer life expectancy who lack contraindications to therapy should be offered standard treatment.
Although the literature about management in older colon patients with cancer has expanded considerably, there is a paucity of data sur-rounding causes of mortality in this population. Research in other tu-mour types emphasizes the importance of this outcome when assessing patients for potentially curative treatments [22–24].