Patterns of Care of Elderly Patients with Metastatic Colorectal Cancer — ASN Events

Patterns of Care of Elderly Patients with Metastatic Colorectal Cancer (#100)

Sagun Parakh 1 , Sayed Ali 1 , Hui-li Wong 2 , Kathryn Field 3 , Jeremy Shapiro 4 , Joe McKendrick 5 , Louise Nott 6 , Peter Gibbs 3 , Desmond Yip 1
  1. The Canberra Hospital, Canberra, ACT, Australia
  2. Systems Biology and Personalised Medicine Division, Walter and Eliza Hall Institute, Melbourne, VIC, Australia
  3. Medical Oncology, Royal Melbourne Hospital , Melbourne, VIC, Australia
  4. Medical Oncology, Alfred Hospital, Melbourne, VIC, Australia
  5. Medical Oncology, Box Hill Hospital, Eastern Health, Melbourne, VIC, Australia
  6. Medical Oncology, Royal Hobart Hospital, Hobart, TAS, Australia

Aim: Elderly patients (pts) account for a large proportion of pts with metastatic colorectal cancer (mCRC). Despite this they are underrepresented in clinical trials and often undertreated. The purpose of this study is to review the patterns of care of elderly pts with mCRC in the community setting.

Methods: Retrospective analysis of 507 elderly (ageĀ > 65 years (yrs)) pts with mCRC on the TRACC (Treatment of Recurrent and Advanced Colorectal Cancer) database enrolled between July 2009 - November 2012. Comprehensive clinical data was collected prospectively on pts with mCRC from 14 sites across Australia. In this analysis pts were grouped according to age: 65-75, 75-85 & >85 yrs. Treatment patterns and intent, performance status (PS), and overall survival (OS) were analysed by age cohorts. Kaplan-Meier method was used for survival analysis.

Results: In this cohort, 213 (42.0%), 216 (42.6%) and 78 (15.4%) pts were aged 65-75, 75-85 and >85 yrs respectively. Older patients were more likely to be female (30.5% vs 42.1% vs 52.6%) and have worse PS (PS>2: 18.3% vs 25.9% vs 48.7%). There were no differences in comorbidity score, primary tumour site or resection rates between age groups. 358 (70.6%) elderly pts received chemotherapy. Chemotherapy use declined with increasing age (83.1% vs 70.8% vs 35.9%, p<0.0001). Among very elderly (>85 yrs) pts who received chemotherapy (n=28), 12 (42.9%) received combination chemotherapy and 6 (21.4%) were given bevacizumab. Median OS was 24.3, 17.7 and 11.3 months in the 65-75, 75-85 and >85 yrs age groups respectively. Pts receiving chemotherapy had significantly longer OS than those who did not (median OS 22.7 vs 6.4 months, HR 0.28 (95% CI 0.21-0.38, p<0.0001)).

Conclusion: Multiple studies have confirmed the safety and efficacy of fluorouracil and bevacizumab but in our cohort, chemotherapy and bevacizumab appear to be underutilised in the elderly. Chart review is planned to explore reasons for not administering chemotherapy.