e-Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2020

Age of uncertainty: the management of older patients diagnosed with colorectal cancer (#251)

Chen Yong 1 , Carol Holden 2 , Elizabeth Buckley 3 , Dagmara Poprawski 4 , Deborah Turnbull 5 , Julie Ratcliffe 6 , Nimit Singhal 1 , David Roder 3 , Matthias Wichmann 4 , Timothy Price 7
  1. Royal Adelaide Hospital, Adelaide, South Australia, Australia
  2. South Australian Health and Medical Research Institute, Adelaide, SOUTH AUSTRALIA, Australia
  3. Cancer Epidemiology and Population Health Research Group, University of South Australia, Adelaide, South Australia, Australia
  4. Mount Gambier Regional Hospital, Mount Gambier, South Australia, Australia
  5. School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
  6. College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
  7. The Queen Elizabeth Hospital, Adelaide, South Australia, Australia

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.