Jorgensen Mikaela L, Young Jane M, Dobbins Timothy A, Solomon Michael J
Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, Sydney Medical School, University of Sydney, NSW, Australia.
Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, Sydney Medical School, University of Sydney, NSW, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and University of Sydney, NSW, Australia.
J Geriatr Oncol. 2014 Jul;5(3):323-30. doi: 10.1016/j.jgo.2014.02.007. Epub 2014 Mar 20.
To investigate the effect of patient age on receipt of stage-appropriate adjuvant therapy for colorectal cancer in New South Wales, Australia.
A linked population-based dataset was used to examine the records of 580 people with lymph node-positive colon cancer and 498 people with high-risk rectal cancer who underwent surgery following diagnosis in 2007/2008. Multilevel logistic regression models were used to determine whether age remained an independent predictor of adjuvant therapy utilisation after accounting for significant patient, surgeon and hospital characteristics.
Overall, 65-73% of eligible patients received chemotherapy and 42-53% received radiotherapy. Increasing age was strongly associated with decreasing likelihood of receiving chemotherapy for lymph node-positive colon cancer (p<0.001) and radiotherapy for high-risk rectal cancer (p=0.003), even after adjusting for confounders such as Charlson comorbidity score and ASA health status. People aged over 70years for chemotherapy and over 75years for radiotherapy were significantly less likely to receive treatment than those aged less than 65. Emergency resection, intensive care admission, and not having a current partner also independently predicted chemotherapy nonreceipt. Other predictors of radiotherapy nonreceipt included being female, not being discussed at multidisciplinary meeting, and lower T stage. Adjuvant therapy rates varied widely between hospitals where surgery was performed.
There are continuing age disparities in adjuvant therapy utilisation in NSW that are not explained by patients' comorbidities or health status. Further exploration of these complex treatment decisions is needed. Variation by hospital and patient characteristics indicates opportunities to improve patient care and outcomes.
调查患者年龄对澳大利亚新南威尔士州结直肠癌患者接受合适分期辅助治疗的影响。
使用一个基于人群的关联数据集，检查了2007/2008年诊断后接受手术的580例淋巴结阳性结肠癌患者和498例高危直肠癌患者的记录。采用多水平逻辑回归模型，在考虑患者、外科医生和医院的显著特征后，确定年龄是否仍然是辅助治疗使用的独立预测因素。
总体而言，65 - 73%的符合条件的患者接受了化疗，42 - 53%的患者接受了放疗。即使在调整了如查尔森合并症评分和美国麻醉医师协会健康状况等混杂因素后，年龄增长与淋巴结阳性结肠癌患者接受化疗的可能性降低（p<0.001）以及高危直肠癌患者接受放疗的可能性降低（p = 0.003）密切相关。70岁以上接受化疗和75岁以上接受放疗的患者比65岁以下的患者接受治疗的可能性显著降低。急诊切除、入住重症监护病房以及没有当前伴侣也独立预测了未接受化疗。未接受放疗的其他预测因素包括女性、在多学科会议上未被讨论以及较低的T分期。进行手术的医院之间辅助治疗率差异很大。
新南威尔士州在辅助治疗使用方面存在持续的年龄差异，这不能用患者的合并症或健康状况来解释。需要进一步探索这些复杂的治疗决策。医院和患者特征的差异表明有机会改善患者护理和治疗结果。
