Characteristics, Therapeutic Approaches and Outcomes of Patients Older than 80 Years Old with Metastatic Colorectal Cancer Compared with Younger Patients

TL;DR

This study compares older and younger patients with metastatic colorectal cancer, finding differences in cancer characteristics and treatment patterns.

Contribution

The study provides insights into treatment feasibility and outcomes for patients over 80 with metastatic colorectal cancer.

Findings

Older patients more frequently had right-sided primary colon cancer compared to younger patients.

Younger patients were more likely to have stage 4 disease at diagnosis and higher CEA levels.

Tailored treatment for older patients aged 80 and above is feasible and can improve outcomes.

Abstract

Background: While advances in therapies have improved metastatic cancer survival rates, elderly patients with colorectal cancer often experience delayed diagnoses, receive less frequent systemic therapies, and show inferior survival outcomes compared to younger groups. Patients over the age of 80 years old face greater treatment risks due to frailty and comorbidities. In this article, we examine characteristics, treatment and outcomes in older adults with metastatic colorectal cancer. Methods: The medical records of all patients aged 80 years and above and comparable patients aged 65–75 years old, who were diagnosed with stage 4 colorectal cancer at a cancer center over a six-year period, were retrospectively reviewed. Results: Patients in the 80 years old and older group more frequently had right-sided primary colon cancer (71.5%), compared to younger patients aged 65–75 years old (34.1%, p = 0.006). Patients in the younger cohort more commonly presented with stage 4 disease at initial diagnosis (59.5%) compared to older patients (22.2%). Elevated carcinoembryonic antigen (CEA) levels were more commonly identified in younger metastatic patients (76.3% vs. 46.4%, p = 0.013). Patients in the younger age group were more likely to have received previous neoadjuvant and adjuvant chemotherapy prior to metastatic progression (p = 0.02, and p = 0.01); however, a significant difference in palliative chemotherapy was not identified between the age groups of metastatic patients. The adverse effects of chemotherapy treatment were similar between the age groups. Conclusions: The active treatment of metastatic colorectal cancer in patients aged 80 and above is feasible when tailored according to the patients’ performance status, comorbidities, and life expectancy. Understanding metastatic disease presentations in elderly patients can improve treatment outcomes in this challenging-to-treat group.

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