Does age influence treatment for rectal cancer?

This study examined whether age influences the type of treatment that a patient will receive. It also examined the implication of these differences on patient outcomes.

Rectal cancer most commonly affects the elderly, with the average age of diagnosis being 70 years. Due to increased life expectancy the number of rectal cancer patients is expected to increase. A number of different treatment options exist for rectal cancer. Surgical techniques include local resection (removal of the tumor and a small amount of normal tissue around it) and anterior resection (the rectum and part of the intestine can be removed). Patients can also be treated with a combination of chemotherapy and radiotherapy (radiochemotherapy).

Guidelines are in place for the treatment of rectal cancer, but these mainly describe treatment strategies for patients under 75 years. This study aimed to evaluate if older patients receive different treatment than younger patients and if so, what the impact is on patient outcome.

This study included 837 patients with rectal cancer. Patients were separated based on age: younger than 75 (504 patients), 75-79 (140 patients), 80-84 (118 patients), and older than 85 (75 patients). Patient age was found to alter the type of treatment given and the level of optimism relating to whether cure was judged possible.

In patients younger than 75: radiochemotherapy was given to 22.9%, local resection was performed in 3.7% and anterior resection in 66.6%. Tumors reappeared in only 5.3% of patients after surgical removal.

In patients aged 75-79: radiochemotherapy was given to 19.3%, local resection was performed in 14.7% and anterior resection in 54.1%. Tumors reappeared in 8.3 % of patients after surgical removal. 

In patients aged 80-84: radiochemotherapy was given to 10.2%, local resection was performed in 13.6% and anterior resection in 56.8%. Tumors reappeared in 12.8% of patients after surgical removal. 

In patients older than 85: radiochemotherapy was only given to 2%, local resection was performed in 24.5% and anterior resection in 49% Tumors reappeared in 22.3 % of patients after surgical removal.

However, despite these clear differences in treatment received, when age was taken into account, no differences in the relative survival rate was found: 76.4% (younger than 75), 72.6% (age 75-79), 72.9% (age 80-84) and 72.3% (age 85 or older).

The authors concluded that patient age caused the treatment to be modified. This was associated with increased local recurrences in the eldest patients, although no certain effect on survival was seen.

This study was carried out in Norway. Results may not match those seen in other countries.