Alvarez, Martin, MD

Meikle, Daniel, MD

Park, John S, MD

Wiseman, Mark, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of SurgeryColorectal Cancer in Nonagenarians: TreatmentDecisions and OutcomesDaniel Meikle MDLehigh Valley Health Network, Daniel.Meikle@lvhn.orgMartin Alvarez MDLehigh Valley Health Network, martin.alvarez@lvhn.orgMark Wiseman MDLehigh Valley Health Network, mark.wiseman@lvhn.orgJohn S. Park MDLehigh Valley Health Network, John_S.Park@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/surgeryPart of the Other Medical Specialties Commons, and the Surgery CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtMeikle DL., Alvarez MP., Wiseman M., & Park JS. (2016, April 1). Colorectal Cancer in Nonagenarians: Treatment Decisions andOutcomes. Poster presented at: Pennsylvania Society of Colon and Rectal Surgeons, Philadelphia, PA.From 2008-2012, approximately 12% of colorectal cancers were diagnosed in patients 85 years of age or older.  While this age group currently represents 2% of the U.S. population, it is estimated that by 2040, this age cohort will more than double in size, to over 14.7 million.  Consequently, the number of colorectal cancers diagnosed in the elderly will rise steadily as well.  Cancer treatment in the elderly population poses several challenges, both physiologically and ethically.  While several studies have looked at elderly patients with colorectal cancer, few have specifically examined nonagenarians as a subgroup.  The purpose of our study was to examine outcomes of nonagenarians diagnosed with colorectal cancer at LVHN, as well as to determine some of the factors involved in the decision-making process regarding choice of treatment.© 2016 Lehigh Valley Health NetworkRetrospective review of patients in the LVHN Tumor Registry from the 10-year period 2005-2014.  We identified those patients who had any surgical intervention, and those that chose no treatment. We then compared 1-year survival for the 2 groups.  We also examined the factors involved in treatment decision, including Modified Frailty Score (MFS), presence of surrogate decision-maker, and presence of metastatic disease.  For those patients who chose surgical intervention, we examined their outcomes, including postoperative morbidity and mortality, and long-term survival.  Statistical analysis was performed using Chi-square analysis and logistic regression.106 patients were included in the study; 71 underwent surgical intervention, while 35 chose no treatment.  Patients who chose surgical intervention had a higher 1-year survival compared to those who chose no treatment (54.9% vs 17.1%, p<0.0005).  Metastatic disease  (p<0.0005) and presence of surrogate decision-maker (p=0.004) were predictive of declining treatment.  For patients in the surgery group, mean survival was 23.7 months, and 5-year survival was 9.9%.  The vast majority of the surgical patients had a procedure with curative intent (80.3%).  Postoperative mortality for the group was 14%, while morbidity was 32.4%.  Postoperative mortality for those patients undergoing curative surgery was 8.8%.  Increased Modified Frailty Score was not found in patients declining treatment or in patients with poor surgical outcomes.Nonagenarian patients diagnosed with colorectal cancer have a significantly higher 1-year survival with surgical intervention compared to those who decline treatment.  Surgery can be performed in these patients with acceptable postoperative mortality and 1-yr survival, especially in those patients having curative resection.  Modified Frailty Score was not useful as a predictor in neither treatment decision-making nor surgical outcomes.POA/NOK = power of attorney or next of kin surrogate decision maker.Lehigh Valley Health Network, Allentown, PAColorectal Cancer in Nonagenarians:  Treatment Decisions and OutcomesMeikle DL, Alvarez MP, Wiseman M, Park JSTable 1: Outcomes Comparing Surgery vs No Surgery  Surgery(n=71 pts)No Surgery(n=35 pts)p-value1-yr survival 54.9% 17.1% p<0.0005Metastatic disease 9.9% 50%POA/NOK 7.0% 28.6% p=0.004High-risk MFS 56.3% 48.6% nsAssisted living 21.1% 31.4% nsPurposeMethodsConclusionsResults

Colorectal Cancer in Nonagenarians: Treatment Decisions and Outcomes

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1828&context=surgery

Colorectal Cancer in Nonagenarians: Treatment Decisions and Outcomes

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