Impact of age on the use of adjuvant treatments in patients undergoing surgery for colorectal cancer: patients with stage III colon or stage II/III rectal cancer
Por:
Sarasqueta, C, Perales, A, Escobar, A, Bare, M, Redondo, M, de Larrea, N, Briones, E, Piera, J, Zunzunegui, M, Quintana, J, Quintana, J, Rivas, F, Morales-Suarez, M, Blasco, J, del Cura, I, Arostegui, I, Bilbao, A, Gonzalez, N, Garcia-Gutierrez, S, Lafuente, I, Aguirre, U, Calzada, M, Martin, J, Anton-Ladislao, A, Tora, N, Pont, M, del Martinez, M, Loizate, A, Zabalza, I, Errasti, J, Gimeno, A, Lazaro, S, Comas, M, Enriquez-Navascues, J, Placer, C, Perales, A, Urkidi, I, Erro, J, Cormenzana, E, Lacasta, A, Piera, P, Campano, E, Sotelo, A, Gomez-Abril, S, Medina-Cano, F, Alcaide, J, Del Rey-Moreno, A, Alcantara, M, Campo, R, Casalots, A, Pericay, C, Gil, M, Pera, M, Collera, P, Espinas, J, Martinez, M, Espallargues, M, Almazan, C, Dujovne, P, Fernandez-Cebrian, J, Anula, R, Mayol, J, Cantero, R, Guadalajara, H, Heras, M, Garcia, D, Morey, M, Colina, A and REDISECC-CARESS CCR Grp
Publicada:
25 jul 2019
Resumen:
BackgroundMany older patients don't receive appropriate oncological treatment. Our aim was to analyse whether there are age differences in the use of adjuvant chemotherapy and preoperative radiotherapy in patients with colorectal cancer.MethodsA prospective cohort study was conducted in 22 hospitals including 1157 patients with stage III colon or stage II/III rectal cancer who underwent surgery. Primary outcomes were the use of adjuvant chemotherapy for stage III colon cancer and preoperative radiotherapy for stage II/III rectal cancer. Generalised estimating equations were used to adjust for education, living arrangements, area deprivation, comorbidity and clinical tumour characteristics.ResultsIn colon cancer 92% of patients aged under 65years, 77% of those aged 65 to 80years and 27% of those aged over 80years received adjuvant chemotherapy (chi(2)(trends)<0.001). In rectal cancer preoperative radiotherapy was used in 68% of patients aged under 65years, 60% of those aged 65 to 80years, and 42% of those aged over 80years (chi(2)(trends)<0.001). Adjusting by comorbidity level, tumour characteristics and socioeconomic level, the odds ratio of use of chemotherapy compared with those under age 65, was 0.3 (0.1-0.6) and 0.04 (0.02-0.09) for those aged 65 to 80 and those aged over 80, respectively; similarly, the odds ratio of use of preoperative radiotherapy was 0.9 (0.6-1.4) and 0.5 (0.3-0.8) compared with those under 65years of age.ConclusionsThe probability of older patients with colorectal cancer receiving adjuvant chemotherapy and preoperative radiotherapy is lower than that of younger patients; many of them are not receiving the treatments recommended by clinical practice guidelines. Differences in comorbidity, tumour characteristics, curative resection, and socioeconomic factors do not explain this lower probability of treatment. Research is needed to identify the role of physical and cognitive functional status, doctors' attitudes, and preferences of patients and their relatives, in the use of adjuvant therapies.
Filiaciones:
Sarasqueta, C:
Donostia Univ Hosp, Biodonostia Hlth Res Inst, Red Invest Serv Salud Enfermedades Cron REDISSEC, Paseo Dr Beguiristain S-N, Donostia San Sebastian 20014, Gipuzkoa, Spain
Donostia Univ Hosp, Biodonostia Hlth Res Inst, Donostia REDISSEC, Res Unit, San Sebastian, Spain
Perales, A:
Donostia Univ Hosp, Biodonostia Hlth Res Inst, Red Invest Serv Salud Enfermedades Cron REDISSEC, Paseo Dr Beguiristain S-N, Donostia San Sebastian 20014, Gipuzkoa, Spain
Biodonostia Hlth Res Inst, Donostia San Sebastian, Spain
Escobar, A:
Hosp Basurto, Res Unit, Red Invest Serv Salud Enfermedades Cron REDISSEC, Avda Montevideo 18, Bilbao 48013, Bizkaia, Spain
Basurto Univ Hosp, Res Unit, Bilbao REDISSEC, Bilbao, Spain
Bare, M:
Corp Sanitaria Parc Tauli, Clin Epidemiol & Canc Screening, Red Invest Serv Salud Enfermedades Cron REDISSEC, Parc Tauli 1, Barcelona 08208, Spain
Corp Sanitaria ParcTauli, Sabadell REDISSEC, Clin Epidemiol & Canc Screening, Barcelona, Spain
Redondo, M:
Costa del Sol Hosp, Res Unit, Red Invest Serv Salud Enfermedades Cron REDISSEC, Autovia A-7,Km 187, Malaga 29603, Spain
Costa del Sol Hosp, Malaga REDISSEC, Lab Serv, Malaga, Spain
de Larrea, N:
Inst Salud Carlos III, Canc & Environm Epidemiol Unit, Natl Ctr Epidemiol, Consortium Biomed Res Epidemiol & Publ Hlth CIBER, Avda Monforte de Lemos 5, Madrid 28029, Spain
Inst Salud Carlos III, Natl Ctr Epidemiol, Canc & Environm Epidemiol Unit, Madrid, Spain
Consortium Biomed Res Epidemiol & Publ Hlth CIBER, Madrid, Spain
Briones, E:
Seville Hlth Dist, Andalusian Hlth Serv, Epidemiol Unit, Consortium Biomed Res Epidemiol & Publ Hlth CIBER, Avda Constitut 18, Seville 41071, Spain
Seville Hlth Dist, Epidemiol Unit, Andalusian Hlth Serv, Seville, Spain
Piera, J:
Donostia Univ Hosp, Med Oncol Unit, Paseo Dr Beguiristain 109, Donostia San Sebastian 20014, Gipuzkoa, Spain
Zunzunegui, M:
Univ Montreal, Inst Rech Sante Publ IRSPUM, Dept Med Sociale & Prevent, Pavillon 7101,Salle 3111 7101,Ave Parc, Montreal, PQ H3N 1X9, Canada
Quintana, J:
Galdakao Usansolo Hosp, REDISSEC, Res Unit, Galdakao 48960, Bizkaia, Spain
Quintana, J:
Galdakao Usansolo Hosp, Gaidakao Bizkaia Hlth Serv Res Chron Dis Network, Res Unit, Galdakao, Bizkaia, Spain
Rivas, F:
Costa del Sol Hosp, Epidemiol Serv, Malaga REDISSEC, Malaga, Spain
Morales-Suarez, M:
Univ Valencia, Dept Prevent Med & Publ Hlth, Epidemiol & Publ Hlth Networking Biomed Res Ctr C, Ctr Publ Hlth Res CSISP,Fdn Promot Hlth & Biomed, Valencia, Spain
Blasco, J:
Lain Entralgo Agcy, Hlth Technol Assessment Unit, Madrid, Spain
del Cura, I:
Madrid Reg Dept Hlth, Planning Div, Res & Teaching Support Unit, Primary Care Management,Teaching & Res Off, Madrid, Spain
Arostegui, I:
Univ Basque Country, Dept Appl Math Stat & Operat Res, REDISSEC, Leioa, Spain
Bilbao, A:
Basurto Univ Hosp, Res Unit, Bilbao REDISSEC, Bilbao, Spain
Gonzalez, N:
Galdakao Usansolo Hosp, Gaidakao Bizkaia Hlth Serv Res Chron Dis Network, Res Unit, Galdakao, Bizkaia, Spain
Garcia-Gutierrez, S:
Galdakao Usansolo Hosp, Gaidakao Bizkaia Hlth Serv Res Chron Dis Network, Res Unit, Galdakao, Bizkaia, Spain
Lafuente, I:
Galdakao Usansolo Hosp, Gaidakao Bizkaia Hlth Serv Res Chron Dis Network, Res Unit, Galdakao, Bizkaia, Spain
Aguirre, U:
Galdakao Usansolo Hosp, Gaidakao Bizkaia Hlth Serv Res Chron Dis Network, Res Unit, Galdakao, Bizkaia, Spain
Calzada, M:
Galdakao Usansolo Hosp, Gaidakao Bizkaia Hlth Serv Res Chron Dis Network, Res Unit, Galdakao, Bizkaia, Spain
Martin, J:
Galdakao Usansolo Hosp, Gaidakao Bizkaia Hlth Serv Res Chron Dis Network, Res Unit, Galdakao, Bizkaia, Spain
Anton-Ladislao, A:
Galdakao Usansolo Hosp, Gaidakao Bizkaia Hlth Serv Res Chron Dis Network, Res Unit, Galdakao, Bizkaia, Spain
Tora, N:
Corp Sanitaria ParcTauli, SabadeiVREDISSEC, Clin Epidemiol & Canc Screening, Barcelona, Spain
Pont, M:
Corp Sanitaria ParcTauli, SabadeiVREDISSEC, Clin Epidemiol & Canc Screening, Barcelona, Spain
del Martinez, M:
Basurto Univ Hosp, Dept Med Oncol, Bilbao, Spain
Loizate, A:
Basurto Univ Hosp, Dept Gen Surg, Bilbao, Spain
Zabalza, I:
Galdakao Usansolo Hosp, Dept Histopathol, Galdakao, Spain
Errasti, J:
Araba Univ Hosp, Dept Gen Surg, Vitoria, Spain
Gimeno, A:
Canarias Univ Hosp, Dept Gastroenterol, San Cristobal la Laguna, Spain
Lazaro, S:
Galdakao Usansolo Hosp, Dept Gen Surg, Galdakao, Spain
Comas, M:
Hosp del Mar, Municipal Healthcare Inst IMAS, Barcelona, Spain
Enriquez-Navascues, J:
Donostia Univ Hosp, Dept Gen & Digest Surg, San Sebastian, Spain
Placer, C:
Donostia Univ Hosp, Dept Gen & Digest Surg, San Sebastian, Spain
Perales, A:
Donostia Univ Hosp, Biodonostia Hlth Res Inst, Red Invest Serv Salud Enfermedades Cron REDISSEC, Paseo Dr Beguiristain S-N, Donostia San Sebastian 20014, Gipuzkoa, Spain
Biodonostia Hlth Res Inst, Donostia San Sebastian, Spain
Urkidi, I:
Mendaro Hosp, Dept Gen & Gastrointestinal Surg, Mendaro, Spain
Erro, J:
Zumarraga Hosp, Dept Gen & Gastrointestinal Surg, Zumarraga, Spain
Cormenzana, E:
Bidasoa Hosp, Dept Gen & Gastrointestinal Surg, Hondarribia, Guipuzcoa, Spain
Lacasta, A:
Donostia Univ Hosp, Dept Med Oncol, San Sebastian, Spain
Piera, P:
Donostia Univ Hosp, Dept Med Oncol, San Sebastian, Spain
Campano, E:
Virgen del Rocio Univ Hosp, Inst Biomed Seville IBIS, Seville, Spain
Sotelo, A:
Virgen de Valme Univ Hosp, Dept Surg, Seville, Spain
:
Hosp Dr Peset, Dept Gen & Gastrointestinal Surg, Valencia, Spain
Medina-Cano, F:
Costa del Sol Hlth Agcy, Dept Gen & Gastrointestinal Surg, Marbelia, Spain
Alcaide, J:
Costa del Sol Hlth Agcy, Dept Med Oncol, Marbelia, Spain
Del Rey-Moreno, A:
Antequera Hosp, Dept Surg, Antequera, Spain
Alcantara, M:
Corp Sanitaria Parc Tauli, Coloproctol Unit, Gen & Digest Surg Serv, Sabadell, Spain
Campo, R:
Corp Sanitaria Parc Tauli, Digest Dis Dept, Sabadell, Spain
Casalots, A:
Corp Sanitaria ParcTauli, Pathol Serv, Sabadell, Spain
Pericay, C:
Corp Sanitaria Parc Tauli, Sabadell REDISSEC, Med Oncol Dept, Sabadell, Spain
Gil, M:
Gen & Digest Surg Serv, Parc Salut Mar, Barcelona, Spain
Pera, M:
Gen & Digest Surg Serv, Parc Salut Mar, Barcelona, Spain
Collera, P:
Althaia Xarxa Assistencial Univ, Gen & Digest Surg Serv, Manresa, Spain
Espinas, J:
Catalan Inst Oncol ICO, Dept Hlth, Catalonian Canc Strategy Unit, Barcelona, Spain
Martinez, M:
Basurto Univ Hosp, Dept Med Oncol, Bilbao, Spain
Catalan Inst Oncol ICO, Med Oncol Dept, Barcelona, Spain
Espallargues, M:
Agcy Hlth Qual & Assessment Catalonia AquAS REDIS, Barcelona, Spain
Almazan, C:
Agcy Hlth Qual & Assessment Catalonia AQuAS CIBER, Barcelona, Spain
Dujovne, P:
Alcorcon Fdn Univ Hosp, Dept Gen & Gastrointestinal Surg, Madrid, Spain
Fernandez-Cebrian, J:
Alcorcon Fdn Univ Hosp, Dept Gen & Gastrointestinal Surg, Madrid, Spain
Anula, R:
San Carlos Univ Hosp, Dept Gen & Gastrointestinal Surg, Madrid, Spain
Mayol, J:
San Carlos Univ Hosp, Dept Gen & Gastrointestinal Surg, Madrid, Spain
Cantero, R:
Infanta Sofia Univ Hosp, Dept Gen & Gastrointestinal Surg, Madrid, Spain
Guadalajara, H:
La Paz Univ Hosp, Dept Gen & Gastrointestinal Surg, Madrid, Spain
Heras, M:
La Paz Univ Hosp, Dept Gen & Gastrointestinal Surg, Madrid, Spain
Garcia, D:
La Paz Univ Hosp, Dept Gen & Gastrointestinal Surg, Madrid, Spain
Morey, M:
Primary Care Management Madrid Reg, REDISSEC Res Support Unit, Madrid, Spain
Colina, A:
Cruces Univ Hosp, Dept Gen Surg & Digest Dis, Baracaldo, Spain
Green Published, gold
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