We aimed to compare patterns of adjuvant chemotherapy (AC) use and cancer-related outcomes between elderly (≥70y) and younger (<70y) patients with resected stage III CRC.
We analysed data from the ACCORD-CRC registry(1), which prospectively collects treatment and outcome data from consecutive patients with CRC treated across seven Melbourne hospitals. Patients who underwent resection for stage III CRC from 2005-2018 were included. Variation in treatment, chemotherapy completion rates and disease-free survival (DFS) were compared between elderly and younger patients.
Data was obtained for 1512 patients; median age was 68y and 685 (45%) were ≥70y. Overall, 59% elderly and 94% younger patients received AC. Compared to younger patients, elderly patients were less likely to be offered AC (72% vs 96%, p<0.0001) and when offered, were more likely to decline treatment (15% vs 2.8%; p <0.0001). The most frequent reasons for not offering elderly patients AC were age plus comorbidities, followed by comorbidities alone and age alone (42%, 29% and 23%, respectively). For those who commenced treatment, elderly patients were less likely to receive oxaliplatin (27% vs 85%, p <0.0001) and to complete planned treatment (76% vs 86%, p <0.0001). After 42m median follow up, 3-year DFS rates were higher for patients who received AC regardless of age: 71% vs 64% in elderly (HR 0.72, p=0.046); 77% vs 40% in younger patients (HR 0.26, p <0.0001). In elderly patients who were offered AC, 3-year DFS was higher in those who accepted treatment compared to those who declined (71% vs 59%, HR 0.61, p=0.03).
Almost one third of elderly patients with stage III CRC in this real-world cohort are not offered AC, with almost a quarter of these patients not being offered due to age alone. When offered AC, elderly patients frequently decline treatment, despite it being associated with improved DFS.