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.
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
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.
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
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
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: