Adjuvant treatment for elderly patients with colon cancer. An observational study.

BACKGROUND: Adjuvant 5-fluoruracil-based chemotherapy significantly reduces mortality in patients with stage II-III colon cancer, but is less prescribed with rising age. In this study we were interested in the pattern of adjuvant treatment and possible effects on survival among elderly patients. PATIENTS AND METHODS: From January to December 2004, 63 questionnaires on the management of stage II-III resected colon cancer patients aged over 70 years, collected from 10 Italian Centres, were retrospectively examined. Determinants of receipt of adjuvant chemotherapy and their relation to survival were considered. RESULTS: The proportion of elderly patients receiving adjuvant chemotherapy was 79.4%, distinct of age, gender, educational level and comorbidities. Grade 3-4 toxicities were the following: haematological in 4 (8.5.%) patients, mucositis in 4 (8.5%), diarrhoea in 2 (4.2%) and nausea in 1 (2.1%). The disease-free survival (DFS) and overall survival (OS) at two years were 79.9% and 95.6%, respectively. Due to the paucity of events, the impact of prognostic factors (patient's age and comorbidity, tumour stage and grade) on DFS and OS could not be assessed. CONCLUSION: An increasing proportion of elderly patients with colon cancer may be treated with a tolerability and OS similar to those observed in the younger population. Development of age-based guidelines and increased awareness of both physicians and patients through education is important to prevent undertreatment of those elderly patients who are eligible for chemotherapy.

Palliative treatment for elderly patients with colon cancer in ten Italian medical oncology units.

BACKGROUND: Palliative chemotherapy significantly reduces mortality in patients with stage IV colon cancer, but is less prescribed with rising age. In this paper, we highlight the pattern of palliative treatment and possible effects on survival among elderly patients. PATIENTS AND METHODS: From January to December 2004, 78 files on the management of stage IV colorectal cancer (CRC) patients over 70 years, collected from 10 Italian Centres, were retrospectively examined. Determinants of receipt of palliative chemotherapy and their relation to toxicity and survival were considered. RESULTS: The proportion of elderly patients receiving first-line palliative chemotherapy was 98.7% and it was evaluated according to age, gender, educational level and comorbidities; patients receiving second-line therapy comprised 47.4%, those receiving third-line therapy 14.1% and those treated with a fourth-line therapy totalled 2.6%. Forty-one percent of patients received best supportive care (BSC) alone. CONCLUSION: In Italy, a proportion of elderly patients with metastatic chemonaive CRC are usually treated with a tolerability and overall survival similar to those for the younger population. Among progressive patients after second-line therapy, 45.8% usually undergo third line therapy; the remaining 54.2% undergo BSC.

Colorectal cancer treatment in elderly patients: results of a retrospective analysis addressed to the chiefs of medical oncology units in Italy.

BACKGROUND: The aim of this retrospective analysis was to evaluate the differences of 1-year treatment and chemotherapy related-toxicity in elderly colorectal cancer (CRC) patients in different Italian medical oncology units. PATIENTS AND METHODS: An open questionnaire on the management of CRC patients over 70 years of age, from January to December 2004, was sent to Italian centres. One hundred and seventy-five files from 10 centres were analysed. Variables considered were age, gender, educational level, comorbidities and modality of therapy administration. RESULTS: In only a minority of units were there some staff specifically dedicated to the older patients in close cooperation with geriatricians and the Multidimensional Geriatric Assessment (MGA) was not routinely used (11.2%-16.8% of cases). Only 5.7% patients were routinely enrolled in a protocol. In total, 95 out of 175 (54.3%) of CRC underwent adjuvant chemotherapy and 80 out of 175 (45.7%) received palliative chemotherapy. Of the patients who underwent adjuvant chemotherapy, 75.6% immediately accepted postoperative treatment while 12.2% were initially dubious but subsequently agreed. Only 5.5 and 9.7% of these patients reported very bad or bad tolerability, respectively. At disease progression, 62.5% patients accepted chemotherapy instantly while 33.3% accepted subsequently. Only 1.3% cases reported very bad and 1.3% bad tolerability. CONCLUSION: In those units in which the problem of the elderly is actually recognised, CRC treatment is adequate, not influenced by age discrimination but inhomogeneous. In the future, standardizing treatment in different oncology units could prove to be beneficial to this population.