Colon cancer treatment and adherence to national guidelines: Does age still matter?

IntroductionIn the past decades, much attention has been given to the risks of undertreatment of cancer in older patients. We set out to determine whether current treatment of colon cancer in older patients still differs from younger patients and to identify risk factors and physician's reasons for deviation from Dutch treatment guidelines.Patients and methodsRetrospective cohort study of all consecutive patients newly diagnosed with colon cancer at the Slotervaart Hospital in Amsterdam from January 2002 to December 2007. Data were collected using clinical charts.ResultsOf 286 patients, 183 were 70 years or older. Ninety-one percent of older patients received curative surgery and 32% received adjuvant chemotherapy in accordance with guidelines compared to 100% and 85% in the younger group (p = 0.002 and p < 0.001 respectively). The primary reasons stated by the treating physician for withholding surgery were comorbidity and poor general health. For adjuvant chemotherapy, the main reason stated was age. For both surgery and chemotherapy, multivariate analysis revealed that deviation from guidelines was most strongly associated with age (surgery OR 1.18 (CI 1.06–1.30); p = 0.002 and chemotherapy OR 1.19 (CI 1.08–1.31); p < 0.001 respectively). Despite this selection, older patients experienced more postoperative morbidity and mortality than younger patients. Chemotherapy toxicity was equal in both groups, despite less aggressive regimens for older patients.ConclusionAt our centre, guideline adherence for surgery in older patients was high, and deviations were well motivated. Age still seems to be the most important factor for withholding chemotherapy, despite evidence suggesting benefit in selected older patients.