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Guideline versus non-guideline based management of rectal cancer in octogenarians

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Abstract

Purpose

The number of octogenarians with rectal adenocarcinoma is growing. Current guidelines seem difficult to apply on octogenarians which may result in non-adherence. The aim of this retrospective cohort study is to give insight in occurrence of treatment-related complications, hospitalisations and survival among octogenarians treated according to guidelines versus octogenarians treated otherwise.

Methods

108 octogenarians with rectal adenocarcinoma were identified by screening of medical records. 22 patients were excluded for treatment process analysis because of stage IV disease or unknown stage. Baseline characteristics, diagnostic process, received treatment, motivation for deviation from guidelines, complications, hospitalisations and date of death were documented. Patients were divided in two groups depending on adherence to treatment guidelines. Differences in baseline characteristics, treatment-related complications and survival between both groups were evaluated.

Results

Diagnosis and treatment according to guidelines occurred in 95 and 54% of the patients, respectively. When documented, patient’s preference and comorbidities were major reasons to deviate from guidelines. 66% of patients who were treated according to guidelines experienced complications versus 34% of those treated otherwise (p = 0.02). After adjustment for differences in age and polypharmacy, this association was not significant. Patients treated according to the guideline had better survival 18 months after diagnosis (80 versus 56%, p = 0.02).

Conclusions

Treating octogenarians with rectal cancer according to guidelines seem to lead to better overall survival, but may lead to a high risk of complications. This may jeopardise quality of life. More and prospective studies in octogenarians with rectal cancer are needed to customize guidelines for these patients.

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Authors and Affiliations

  1. Department of Internal Medicine-Medical Oncology, Zuyderland MC, Dr. H. Van der Hoffplein 1, Postbus 5500, 6130 MB, Sittard-Geleen, The Netherlands

    A. van Vuuren & F. van den Berkmortel

  2. Department of Internal Medicine-Medical Oncology, VieCuri Medical Centre, Tegelseweg 210, 5912 BL, Venlo, The Netherlands

    L. Verhoeven & Y. van de Wouw

  3. Department of Gastrointestinal Surgery, Zuyderland MC, Postbus 5500, 6130 MB, Sittard-Geleen, The Netherlands

    E. Belgers

  4. Department of Surgery, VieCuri Medical Centre, Tegelseweg 210, 5912 BL, Venlo, The Netherlands

    F. J. Vogelaar

  5. Department of Clinical Epidemiology, VieCuri Medical Centre, Tegelseweg 210, 5912 BL, Venlo, The Netherlands

    M. L. Janssen-Heijnen

  6. Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands

    M. L. Janssen-Heijnen

Authors
  1. A. van Vuuren
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  2. L. Verhoeven
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  3. F. van den Berkmortel
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  4. Y. van de Wouw
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  6. F. J. Vogelaar
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  7. M. L. Janssen-Heijnen
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Contributions

Study concept: FB, AV. Study design: FB, AV, MLJ-H. Data acquisition: AV, LV. Quality control of data and algorithms: AV, MLJ-H. Data analysis and interpretation: AV, FB, YW, EB, FJV, MLJ-H. Statistical analysis: AV, MLJ-H. Manuscript preparation: AV, FB, YW, MLJ-H. Manuscript editing: AV, FB, YW, EB, FJV, MLJ-H. Manuscript review: AV, FB, YW, EB, FJV, MLJ-H.

Corresponding author

Correspondence to F. van den Berkmortel.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

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van Vuuren, A., Verhoeven, L., van den Berkmortel, F. et al. Guideline versus non-guideline based management of rectal cancer in octogenarians. Eur Geriatr Med 9, 533–541 (2018). https://doi.org/10.1007/s41999-018-0070-2

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  • DOI: https://doi.org/10.1007/s41999-018-0070-2

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