Aim: We undertook a clinical audit of patients diagnosed with colorectal cancer (CRC) to examine factors that impact on multi-disciplinary team (MDT) decision-making and CRC management of older patients.
Methods: All patients with a CRC diagnosis (2010-2019) admitted to a single regional public hospital (n=449) were included. De-identified data was extracted from the hospital patient management system and managed using a secure, web-based application (REDCap). Data collected included non-identifying demographics, CRC diagnosis and tumour stage, MDT referral outcomes and other treatment decision-making variables. Key study factors were compared for younger (<75 years) and older (>=75 years) age at diagnosis. SA Department Health and Wellbeing HREC approved the study.
Results: For completed cases to date (N=216), 44% were >=75 years old at diagnosis (median 72, 40-96 years). About 80% of patients were referred to a MDT (N=177), with no difference between younger (84%) and older patients (79%) (X2 (N=212) = 0.822, p = .36). However, for patients with advanced CRC (Stage III-IV), more younger (95%) vs older (82%) patients were referred (X2 (N=103) = 4.532, p = .033). Age-related MDT referral difference was also observed for patients with more complex disease (advanced stage and comorbidities) (97% vs 77%, respectively) (X2 (N=72) = 4.353, p = .037). Although there was a tendency for less MDT adjuvant therapy recommendations for older patients, curative therapy recommendations were similar for younger (52%) and older (48%) patients (X2 (N=90) = 2.4012, p = .121).
Conclusions: Despite limited clinical guidance on the management of older patients (>75 years), age did not appear to predict MDT access or treatment recommendation at this site. However, age-related disparities were evident when patients also presented with more advanced/complex disease, which might partly account for evidence of slower rates of CRC survival improvements for older compared to younger patients.