van Vuuren A, Verhoeven L, van den Berkmortel F, van de Wouw Y, Belgers E, Vogelaar F J, Janssen-Heijnen M L
Department of Internal Medicine-Medical Oncology, Zuyderland MC, Dr. H. Van der Hoffplein 1, Postbus 5500, 6130 MB, Sittard-Geleen, The Netherlands.
Department of Internal Medicine-Medical Oncology, VieCuri Medical Centre, Tegelseweg 210, 5912 BL, Venlo, The Netherlands.
Eur Geriatr Med. 2018 Aug;9(4):533-541. doi: 10.1007/s41999-018-0070-2. Epub 2018 May 28.
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.
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.
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).
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.
患有直肠腺癌的八旬老人数量正在增加。目前的指南似乎难以应用于八旬老人，这可能导致不依从。这项回顾性队列研究的目的是深入了解按照指南治疗的八旬老人与未按指南治疗的八旬老人相比，治疗相关并发症、住院情况和生存率的发生情况。
通过筛查病历确定了108名患有直肠腺癌的八旬老人。由于IV期疾病或分期不明，22名患者被排除在治疗过程分析之外。记录了基线特征、诊断过程、接受的治疗、偏离指南的原因、并发症、住院情况和死亡日期。根据对治疗指南的依从性将患者分为两组。评估了两组之间基线特征、治疗相关并发症和生存率的差异。
分别有95%和54%的患者按照指南进行诊断和治疗。记录显示，患者的偏好和合并症是偏离指南的主要原因。按照指南治疗的患者中有66%发生了并发症，而未按指南治疗的患者中这一比例为34%（p = 0.02）。在调整年龄和多种药物治疗差异后，这种关联并不显著。按照指南治疗的患者在诊断后18个月的生存率更高（80%对56%，p = 0.02）。
按照指南治疗患有直肠癌的八旬老人似乎能带来更好的总体生存率，但可能导致较高的并发症风险。这可能会危及生活质量。需要对患有直肠癌的八旬老人进行更多前瞻性研究，以定制适合这些患者的指南。
