Elderly patients with colorectal cancer: treatment modalities and survival in France. National data from the ThInDiT cohort study

Background: Few data exist on how elderly patients with colorectal cancer (CRC) are actually treated in real-life practice. Based on a national cohort, we analysed routine treatment modalities of the elderly who were diagnosed with CRC in France in 2009.

Patients and methods: The characteristics of patients and tumours and the cancer treatments received during the first year of all national incident cases of CRC diagnosed between 1st April and 31st December 2009, were compared between a 'younger group' (YG), under 75 years of age (N = 18,410 patients), and an 'older group' (OG), aged 75 and over (N = 13,255 patients). In the OG with metastases at baseline, we analysed two-year overall survival (OS) according to the treatment received (e.g. chemotherapy, surgery) and well-known prognostic factors.

Results: Among patients with localised CRC (N = 25,353), surgery was equally performed in both groups in more than 80% of the cases (p=0.52); time to surgery was shorter in the OG (8 versus 23 days) because there was more emergency surgery for occlusion among the OG. Adjuvant chemotherapy was performed in 15% of the OG (versus 29% in the YG) and consisted of 5-fluorouracil (5FU) monotherapy in more than 50% of OG patients. Among patients with metastatic CRC (N = 6,312), palliative chemotherapy was given to 48% of the OG versus 85% of the YG. Chemotherapy regimens included 30% monotherapy with 5FU, 30% oxaliplatin combination and 20% bevacizumab combination in the OG; compared to 10%, 34% and 35%, respectively, in the YG. The median OS for the OG was 8.4 months (versus 22.3 months in the YG) and 17.1 months among elderly patients who received chemotherapy.

Conclusion: CRC is more frequently complicated at diagnosis among elderly patients. Adjuvant and palliative chemotherapy is less frequently prescribed among elderly patients. This could be explained by the fact that unfit elderly patients do not deserve chemotherapy, but certainly also reflect the fact that some fit elderly patients are undertreated.