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Health & Medicine for Senior Citizens

Seniors See Colorectal Cancer Surgery Decline, Mortality Rates Increase; Still Do Worse in Surgery

The good news is colon cancer surgery rates down and survival rates up, even for elderly; researchers concerned with lack of senior citizens in clinical trials

April 9, 2014 – Senior citizens age 65 and older are the most likely to undergo colorectal cancer surgery and the experience the worse outcomes than do younger patients. The good news is the total number of colon cancer operations has decreased in the last decade and mortality rates have improved.

"Despite the overall improved mortality seen during the past 10 years, the risk-adjusted mortality and morbidity of the elderly continue to be substantially higher than that for the younger population," the study says.

Gastrointestinal cancers are common in the elderly occur most often in the sixth and seventh decades of life. One of these, colorectal cancer (CRC) is a leading cause of death and surgery remains the effective treatment, explained according to background on the study by author Mehraneh D. Jafari, M.D., and colleagues from the University of California, Irvine School of Medicine, Orange.

 

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The researchers examined the trends and outcomes of colorectal cancer surgery in the elderly in a nationwide sample of inpatients from 2001 through 2010. Patients were divided into age groups: 45 to 64, 65 to 69, 70 to 74, 75 to 79, 80 to 84, and 85 years and older.

Among the more than 1 million patients with colorectal cancer included in the study, 63.8 percent of the operations were performed on patients 65 years and older and 22.6 percent on patients 80 years and older.

Patients 80 years and older were 1.7 times more likely to require urgent admission to the hospital than patients younger than 65 years.

Compared to patients 45 to 64 years, higher hospital death and complication rates were seen in older patients.

Patients 80 years and older also had a $9,492 higher hospital charge and a longer length of stay at the hospital (2.5 days longer) compared with patients younger than 65 years.

The total number of colon cancer surgeries decreased an average of 5.1 percent and 7 percent per year for the entire population and the aging population, respectively. Mortality rates improved in all age groups during the decade studied.

 “In this extensive review of national trends of CRS [colorectal cancer resection], we observed that, despite the improvements in mortality and a decrease in the incidence of CRS, older patients continue to have worse risk-adjusted outcomes compared with those who are younger,” the study concluded.

Elderly under studied

"The aging population - age 65 or older - is a rapidly growing segment of the United States. The US census data from 2011 report a total of 39 million elderly, comprising 13% of the population. In fact, projected estimates report a dramatic increase (19%) between 2010 and 2030 in this population as the baby-boomer generation ages into the group 65 years and older," the authors report.

"An estimated 50% of all cancers and 70% of all cancer deaths occur in the elderly. Gastrointestinal malignant neoplasms are considered common cancers in the elderly, with peak incidences in the sixth and seventh decades of life. Despite this increase in the aging population, the elderly are often excluded from clinical trials. This raises concerns that clinical trial data may not accurately reflect morbidity and mortality in the elderly."

The report was published today in the online edition of JAMA Surgery.


Facts from National Cancer Institute

Definition of colon cancer: Cancer that forms in the tissues of the colon (the longest part of the large intestine). Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids). 

Definition of rectal cancer: Cancer that forms in the tissues of the rectum (the last several inches of the large intestine closest to the anus).

Estimated new cases and deaths from colon and rectal cancer in the United States in 2014:

  • New cases: 96,830 (colon); 40,000 (rectal)

  • Deaths: 50,310 (colon and rectal combined)

See the online booklet What You Need To Know About™ Cancer of the Colon and Rectum to learn about colon and rectal cancer symptoms, diagnosis, treatment, and questions to ask the doctor.

For an overview of research advances, see Cancer Advances In Focus: Colorectal Cancer.

 

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