Age-related guideline adherence and outcome in low rectal cancer

Abstract

Background: Care for elderly patients with low rectal cancer can pose dilemmas, because radical total mesorectal excision surgery comes with high morbidity and mortality rates.

Objective: The purpose of this study was to analyze the treatment of patients with low rectal cancer, comparing treatment choices, guideline adherence, and outcomes for elderly patients (≥75 years) with younger patients (<75 years).

Design: Patient data were retrieved from the hospital pathology database and from the hospital prospective colorectal surgery database for surgically treated patients. Records were reviewed for nonadherence to treatment guidelines. Delivered treatment modalities for patients with stage I to III rectal cancer were compared with treatment advised by national guidelines, and reasons stated by the treating physician for nonadherence to guidelines were subsequently collected.

Settings: This study was performed at a high-volume teaching hospital.

Patients: Patients included were those with newly diagnosed rectal cancer (≤10 cm from the anal verge).

Main outcome measures: Treatment decisions, guideline adherence, and outcome of surgical treatment were the main outcome parameters.

Results: Of 218 included patients, 75 (34%) were aged ≥75 years. Guideline adherence for all of the treatment modalities in stage I to III rectal cancer was significantly lower in elderly patients (62% versus 87% for aged <75 years; p < 0.001), and age was the primary reason mentioned for withholding treatment. Palliative anticancer treatment for stage IV disease was also initiated significantly less frequently in elderly patients (60% versus 97%; p = 0.002). Overall rates of treatment complications were similar for both patient groups (p = 0.71), but the impact of complications on survival was much greater for elderly patients (p = 0.002).

Limitations: Data on outcome of other treatment modalities, such as chemotherapy and radiotherapy, are lacking.

Conclusions: Guideline adherence for all of the treatment modalities in stage I to III rectal cancer declines significantly with increasing age. Future research should focus on strategies of treatment tailored to patient health status rather than chronological age.