Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul;45(7):1196-1204.
doi: 10.1016/j.ejso.2019.01.005. Epub 2019 Jan 7.

Rectal cancer in old age -is it appropriately managed? Evidence from population-based analysis of routine data across the English national health service

Rebecca J Birch  1 , John C Taylor  2 , Amy Downing  2 , Katie Spencer  3 , Paul J Finan  2 , Riccardo A Audisio  4 , Christopher M Carrigan  2 , Peter J Selby  5 , Eva J A Morris  2
Affiliations

Rectal cancer in old age -is it appropriately managed? Evidence from population-based analysis of routine data across the English national health service

Rebecca J Birch et al. Eur J Surg Oncol. 2019 Jul.

Abstract

Background: There is significant debate as to where to draw the line between undertreating older rectal cancer patients and minimising treatment risks. This study sought to examine the use of radical rectal cancer treatments and associated outcomes in relation to age across the English NHS.

Methods: Patient, tumour and treatment characteristics for all patients diagnosed with a first primary rectal cancer in England between 1st April 2009 and 31st December 2014 were obtained from the CORECT-R data repository. Descriptive analyses and adjusted logistic regression models were undertaken to examine any association between age and the use of major resection and post-surgical outcomes. Funnel plots were used to show variation in adjusted rates of major resection.

Results: The proportion of patients who underwent a major surgical resection fell from 66.5% to 31.7%, amongst those aged <70 and aged ≥80 respectively. After adjustment, 30-day post-operative mortality, failure to rescue and prolonged length of stay were significantly higher among the oldest group when compared to the youngest. Patient reported outcomes were not significantly worse amongst older patients. Significant variation was observed in adjusted surgical resection rates in the oldest patients between NHS Trusts. The probability of death due to cancer was comparable across all age groups.

Conclusions: Older patients who are selected for surgery have good outcomes, often comparable to their younger counterparts. Significant variation in the treatment of older patients could not be explained by differences in measured characteristics and required further investigation.

Keywords: Age; Cancer; Colorectal; Inequalities; Rectal.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Stoma creation and closure rates for patients who underwent an anterior resection, by age at diagnosis.
Fig. 2
Fig. 2
a: Results from PROMs data for patients whose stoma was not reversed - 'Perfect' health. b: Results from PROMs data for patients whose stoma was not reversed - Embarrassed by stoma.
Fig. 3
Fig. 3
30-day post-operative mortality and return to surgery rates for patients who underwent a major surgical resection, by age at diagnosis.
Fig. 4
Fig. 4
a: Variation in the use of major surgical resection for patients aged ≥80 by NHS Trust. b: Adjusted funnel plot showing rate of resection for patients aged ≥80 by NHS Trust.
Fig. 4
Fig. 4
a: Variation in the use of major surgical resection for patients aged ≥80 by NHS Trust. b: Adjusted funnel plot showing rate of resection for patients aged ≥80 by NHS Trust.
Fig. 5
Fig. 5
Results of adjusted logistic regression models in relation to age group. Each outcome modelled separately (full results of adjusted models available in Appendix A & C).
Fig. 6
Fig. 6
Results of adjusted logistic regression models in relation to age group. Each outcome modelled separately (full results of models available in Appendix D).
Fig. 7
Fig. 7
Crude probability of death by age group and surgical management.
See this image and copyright information in PMC

Comment in

References

    1. Office for National Statistics. Cancer registration statistics, England. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/.... Accessed, November 15, 2017.
    1. Office for National Statistics. National Population Projections: 2016-based statistical bulletin. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigrati.... Accessed, August 31, 2018.
    1. Independent Cancer Taskforce . 2015. Achieving world-class cancer outcomes: a strategy for England 2015-2020.
    1. Macmillan Cancer Support . 2012. The age old excuse: the under treatment of older cancer patients.
    1. Turner N.J., Turner N.J., Haward R.A., Mulley G.P., Selby P.J. Cancer in old age–is it inadequately investigated and treated? Br Med J. 1999;319:309. - PMC - PubMed

MeSH terms