Rectal cancer in old age –is it appropriately managed? Evidence from population-based analysis of routine data across the English national health service
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. Patient, tumour and...
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| Veröffentlicht in: | European journal of surgical oncology 2019-07, Vol.45 (7), p.1196-1204 |
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| container_title | European journal of surgical oncology |
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| creator | Birch, Rebecca J. Taylor, John C. Downing, Amy Spencer, Katie Finan, Paul J. Audisio, Riccardo A. Carrigan, Christopher M. Selby, Peter J. Morris, Eva J.A. |
| description | 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.
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.
The proportion of patients who underwent a major surgical resection fell from 66.5% to 31.7%, amongst those aged |
| doi_str_mv | 10.1016/j.ejso.2019.01.005 |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 0748-7983</identifier><identifier>EISSN: 1532-2157</identifier><identifier>DOI: 10.1016/j.ejso.2019.01.005</identifier><identifier>PMID: 30661923</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Age ; Age Factors ; Aged ; Aged, 80 and over ; Cancer ; Chemoradiotherapy ; Colorectal ; Comorbidity ; Digestive System Surgical Procedures ; England - epidemiology ; Female ; Humans ; Inequalities ; Logistic Models ; Male ; Neoadjuvant Therapy ; Neoplasm Staging ; Patient Reported Outcome Measures ; Postoperative Complications - epidemiology ; Proctectomy ; Psychological Distress ; Radiotherapy ; Rectal ; Rectal Neoplasms - pathology ; Rectal Neoplasms - therapy ; Rectum - surgery ; Retrospective Studies ; State Medicine ; Survival Rate</subject><ispartof>European journal of surgical oncology, 2019-07, Vol.45 (7), p.1196-1204</ispartof><rights>2019 The Authors</rights><rights>Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.</rights><rights>2019 The Authors 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c455t-e1e79d31380621e3ab274703bb2b0204241c082220cf0ad95cd7f89a68f410b93</citedby><cites>FETCH-LOGICAL-c455t-e1e79d31380621e3ab274703bb2b0204241c082220cf0ad95cd7f89a68f410b93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0748798319300058$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30661923$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Birch, Rebecca J.</creatorcontrib><creatorcontrib>Taylor, John C.</creatorcontrib><creatorcontrib>Downing, Amy</creatorcontrib><creatorcontrib>Spencer, Katie</creatorcontrib><creatorcontrib>Finan, Paul J.</creatorcontrib><creatorcontrib>Audisio, Riccardo A.</creatorcontrib><creatorcontrib>Carrigan, Christopher M.</creatorcontrib><creatorcontrib>Selby, Peter J.</creatorcontrib><creatorcontrib>Morris, Eva J.A.</creatorcontrib><title>Rectal cancer in old age –is it appropriately managed? Evidence from population-based analysis of routine data across the English national health service</title><title>European journal of surgical oncology</title><addtitle>Eur J Surg Oncol</addtitle><description>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.
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.
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.
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.</description><subject>Age</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cancer</subject><subject>Chemoradiotherapy</subject><subject>Colorectal</subject><subject>Comorbidity</subject><subject>Digestive System Surgical Procedures</subject><subject>England - epidemiology</subject><subject>Female</subject><subject>Humans</subject><subject>Inequalities</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Staging</subject><subject>Patient Reported Outcome Measures</subject><subject>Postoperative Complications - epidemiology</subject><subject>Proctectomy</subject><subject>Psychological Distress</subject><subject>Radiotherapy</subject><subject>Rectal</subject><subject>Rectal Neoplasms - pathology</subject><subject>Rectal Neoplasms - therapy</subject><subject>Rectum - surgery</subject><subject>Retrospective Studies</subject><subject>State Medicine</subject><subject>Survival Rate</subject><issn>0748-7983</issn><issn>1532-2157</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU2OEzEQhVsIxISBC7BAXrLpULb7V0Kg0Sj8SCMhIVhb1e7qxJFjN7YTKTvuwJLbcRKcyTCCDSsv6r1X5fcVxXMOSw68ebVd0jb6pQDeL4EvAeoHxYLXUpSC1-3DYgFt1ZVt38mL4kmMWwDoZds_Li4kNA3vhVwUPz-TTmiZRqcpMOOYtyPDNbFf33-YyExiOM_Bz8FgIntkO3R5Or5lq4MZKZvYFPyOzX7eW0zGu3LASDnCoT3GnOAnFvw-GUdsxIQMdfAxsrQhtnJra-KGuVtjvmJDaNOGRQoHo-lp8WhCG-nZ3XtZfH23-nL9obz59P7j9dVNqau6TiVxavtRctlBIzhJHERbtSCHQQwgoBIV19AJIUBPgGNf67Gduh6bbqo4DL28LN6cc-f9sKNRk0sBrcpf3mE4Ko9G_TtxZqPW_qCaBnLTIge8vAsI_tueYlI7EzVZi478PirB2152jahOu8RZettCoOl-DQd1oqq26kRVnagq4CpTzaYXfx94b_mDMQtenwWUazoYCipqc4IzmpD5qtGb_-X_BpZKt_U</recordid><startdate>201907</startdate><enddate>201907</enddate><creator>Birch, Rebecca J.</creator><creator>Taylor, John C.</creator><creator>Downing, Amy</creator><creator>Spencer, Katie</creator><creator>Finan, Paul J.</creator><creator>Audisio, Riccardo A.</creator><creator>Carrigan, Christopher M.</creator><creator>Selby, Peter J.</creator><creator>Morris, Eva J.A.</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201907</creationdate><title>Rectal cancer in old age –is it appropriately managed? Evidence from population-based analysis of routine data across the English national health service</title><author>Birch, Rebecca J. ; Taylor, John C. ; Downing, Amy ; Spencer, Katie ; Finan, Paul J. ; Audisio, Riccardo A. ; Carrigan, Christopher M. ; Selby, Peter J. ; Morris, Eva J.A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c455t-e1e79d31380621e3ab274703bb2b0204241c082220cf0ad95cd7f89a68f410b93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Age</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cancer</topic><topic>Chemoradiotherapy</topic><topic>Colorectal</topic><topic>Comorbidity</topic><topic>Digestive System Surgical Procedures</topic><topic>England - epidemiology</topic><topic>Female</topic><topic>Humans</topic><topic>Inequalities</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Staging</topic><topic>Patient Reported Outcome Measures</topic><topic>Postoperative Complications - epidemiology</topic><topic>Proctectomy</topic><topic>Psychological Distress</topic><topic>Radiotherapy</topic><topic>Rectal</topic><topic>Rectal Neoplasms - pathology</topic><topic>Rectal Neoplasms - therapy</topic><topic>Rectum - surgery</topic><topic>Retrospective Studies</topic><topic>State Medicine</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Birch, Rebecca J.</creatorcontrib><creatorcontrib>Taylor, John C.</creatorcontrib><creatorcontrib>Downing, Amy</creatorcontrib><creatorcontrib>Spencer, Katie</creatorcontrib><creatorcontrib>Finan, Paul J.</creatorcontrib><creatorcontrib>Audisio, Riccardo A.</creatorcontrib><creatorcontrib>Carrigan, Christopher M.</creatorcontrib><creatorcontrib>Selby, Peter J.</creatorcontrib><creatorcontrib>Morris, Eva J.A.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Birch, Rebecca J.</au><au>Taylor, John C.</au><au>Downing, Amy</au><au>Spencer, Katie</au><au>Finan, Paul J.</au><au>Audisio, Riccardo A.</au><au>Carrigan, Christopher M.</au><au>Selby, Peter J.</au><au>Morris, Eva J.A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rectal cancer in old age –is it appropriately managed? Evidence from population-based analysis of routine data across the English national health service</atitle><jtitle>European journal of surgical oncology</jtitle><addtitle>Eur J Surg Oncol</addtitle><date>2019-07</date><risdate>2019</risdate><volume>45</volume><issue>7</issue><spage>1196</spage><epage>1204</epage><pages>1196-1204</pages><issn>0748-7983</issn><eissn>1532-2157</eissn><abstract>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.
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.
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.
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.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>30661923</pmid><doi>10.1016/j.ejso.2019.01.005</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of surgical oncology, 2019-07, Vol.45 (7), p.1196-1204 |
| issn | 0748-7983 1532-2157 |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Age Age Factors Aged Aged, 80 and over Cancer Chemoradiotherapy Colorectal Comorbidity Digestive System Surgical Procedures England - epidemiology Female Humans Inequalities Logistic Models Male Neoadjuvant Therapy Neoplasm Staging Patient Reported Outcome Measures Postoperative Complications - epidemiology Proctectomy Psychological Distress Radiotherapy Rectal Rectal Neoplasms - pathology Rectal Neoplasms - therapy Rectum - surgery Retrospective Studies State Medicine Survival Rate |
| title | Rectal cancer in old age –is it appropriately managed? Evidence from population-based analysis of routine data across the English national health service |
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