Age differences seen in rectal cancer treatment

Rectal cancer patients 75 and older are less likely to undergo radiation before undergoing surgery than are younger people with the disease, new research from Sweden shows.

The analysis of data from about 15,000 patients treated for the disease between 1995 and 2004 also showed that older patients were less likely to have advanced disease, but also less likely to survive for 5 years after diagnosis.

Future studies should look at whether age differences in rectal cancer treatment are intentional, Dr. Barbel Jung of Visby Hospital and her colleagues conclude.

Rectal cancer primarily occurs in people 50 and older, Jung and her team note in the journal BMC Cancer, and the aging of the Swedish population means that the disease is becoming increasingly common. While research shows that older people may be less likely to undergo certain procedures, they add, there is growing evidence that relatively healthy older people will benefit from these therapies just as much as younger patients do.

To investigate whether there might be age-related differences in rectal cancer treatment, Jung and her colleagues analyzed data from the Swedish Rectal Cancer Registry, which includes nearly all patients diagnosed with the disease in Sweden since 1995. They looked at 15,104 patients, of whom 42.4 percent were 75 or older.

About 15 percent of the older patients had disease that had spread beyond the colon, compared to nearly 18 percent of the younger patients, the researchers found. The older patients were less likely to have had abdominal surgery to remove their tumors; 68.5 percent had this procedure, compared to 84.4 percent of younger patients.

The researchers also found that the older patients were more than three times as likely as the younger patients to have had an operation called Hartmann's procedure, which requires a colostomy. And while 67.2 percent of the younger patients had radiation treatment before surgery, just 34.3 percent of older patients did.

In terms of survival, 73 percent of the older patients treated with intent to cure lived for 5 years or longer, while 78 percent of the younger patients did. Tumors recurred in the rectal area for 9 percent of the older patients and 8 percent of the younger patients.

More research is needed to understand both the effectiveness of treatments for rectal cancer and how these therapies influence patients' quality of life, the researchers conclude.

SOURCE: BMC Cancer, online February 26, 2009.