Older Patients With Advanced-Stage Rectal Cancer Often Receive Sub-Optimal Treatment

A majority of older patients with stage II or III rectal adenocarcinoma do not receive standard-of-care treatment, according to recent research published in Cancer (online July 31, 2017; doi:10.1002/cncr.30896).

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Older patients (aged 80 years or older) with stage II/III rectal adenocarcinoma are significantly underrepresented in randomized clinical trials that have established the standard-of-care therapy: chemoradiation followed by definitive resection. Limited research exists regarding the impact of standard-of-care therapy in older patients with rectal cancer, as well as factors that determine the likelihood of receiving such treatment.

Richard J Cassidy, MD, department of radiation oncology, Winship Cancer Institute, Emory University (Atlanta, GA), and colleagues conducted a study to evaluate the impact of therapies on overall survival for older patients with stage II/III rectal cancer and to determine predictors of therapy. Researchers utilized the National Cancer Data Base to identify 2723 patients aged 80 years or older with clinical stage II/III disease from 2004 to 2013. Kaplan-Meier analysis, log-rank testing, logistic regression, Cox proportional hazards regression, interaction effect testing, and propensity score-matched analysis were conducted.

Researchers found that 14.9% of patients in the study received no treatment for their disease, 29.7% underwent definitive resection alone, 5.0% underwent short-course radiation and then surgery, and 5.1% underwent surgery followed by chemoradiation, compared with 45.3% who underwent chemoradiation plus surgery.

Additionally, researchers reported that African American race and residence in a less-educated county were associated with not receiving treatment. Male sex, older age, worsening comorbidities, receiving no treatment, and undergoing definitive resection alone were associated with worse overall survival. No statistical difference was identified in overall survival between short-course radiation and then surgery, surgery followed by chemoradiation, and chemoradiation plus surgery.

However, interaction testing showed that chemoradiation plus surgery improved overall survival, regardless of age, comorbidity status, sex, race, and tumor stage.

Researchers concluded that while many older patients with advanced-stage rectal cancer do not receive optimal treatment or any treatment at all due to varying factors, chemoradiation plus surgery should be considered a “reasonable strategy” for older patients who can tolerate therapy.—Zachary Bessette