EPD102 - The Association of Age with Treatment Decisions in Octogenarians and Nonagenarians in Rectal Cancer

ePoster of Distinction Presenter(s)

• SK

  Saher-Zahra Khan, MD

  General Surgery Resident
  University Hospitals Cleveland Medical Center
  South Euclid, OH, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Author(s)

• 

  Emily F. Simon, MD (she/her/hers)

  General Surgery Resident
  University Hospitals Cleveland Medical Center, Department of Surgery
  Cleveland, OH, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• 

  Kayvan Barekatain, MD (he/him/his)

  Resident Physician
  Case Western Reserve University Hospitals
  University Hospitals, Cleveland Medical Center
  Cleveland, OH, United States

  Disclosure information not submitted.
• 

  Marnie Abeshouse, MD

  Colon and Rectal Surgery Fellow
  University Hospitals Cleveland Medical Center
  University Hospitals Cleveland Medical Center
  Cleveland, OH, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• MC

  Meagan Costedio, MD (she/her/hers)

  Medical Director of Colorectal Surgery
  Ahuja Medical Center of University Hospitals
  Case Western University
  Beachwood, OH, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• 

  Ronald Charles, MD (he/him/his)

  Assistant Professor of Surgery
  University Hospitals Cleveland Medical Center, Department of Surgery, Division of Colorectal
  Cleveland, OH, United States

  Disclosure information not submitted.
• ES

  Emily Steinhagen, MD, FACS, FASCRS

  Associate Professor of Surgery
  University Hospitals Cleveland Medical Center, Department of Surgery, Division of Colorectal
  Cleveland, Ohio, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• 

  Kristen Westfall, MD, MPH (she/her/hers)

  Assistant Professor of Surgery
  University Hospitals/Cleveland Medical Center
  Case Western Reserve University
  Cleveland, OH, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Purpose/Background: While advances in surgical treatment and chemoradiation have positively impacted outcomes in rectal cancer across patients of all ages, treatment decisions in the elderly may diverge from guideline-based care due to concerns regarding treatment complications, frailty, and life expectancy. The objective of this study was to characterize treatment decisions in octogenarians and nonagenarians with rectal cancer and compare outcomes.

Methods/Interventions: The National Cancer Database 2004-2022 was used to capture patients with clinical stage 1-3 rectal adenocarcinoma. Patients were stratified into patients aged 65 to 79 years old, octogenarians (aged 80 to 89), and nonagenarians (aged 90 or older). Demographics, clinical stage, treatment decisions, and outcomes were compared between all groups and separately between octogenarians and nonagenarians. Subset analysis of patients who underwent surgery and patients who received palliative were completed. Categorical variables were compared using Chi-squared analysis.

Results/Outcomes: 139,585 patients were included in the analysis of whom 34,567 were octogenarians and 6,102 were nonagenarians. There were significant differences in sex, race, and socioeconomic factors between groups (p < 0.001 for all). More octogenarians (10.3%) and nonagenarians (21.4%) did not receive treatment compared to the younger patients (4.2%) (p < 0.001). Similarly, more octogenarians and nonagenarians refused surgery (7.8% and 16.8%, respectively) or were told it was contraindicated (6.3% and 15.9%) than younger patients (2.2% and 1.3%) (p < 0.001). More octogenarians (4.2%) and nonagenarians (10.3%) received palliative care compared to younger patients (2.2%) (p < 0.001). These treatment decisions were all significant when compared between octogenarians and nonagenarians. In patients that underwent surgery, nonagenarians had higher mortality than octogenarians at 30 days (7.6 vs 4.1%) and 90 days (12.6 vs 7.6%) (p < 0.001). Patients aged 65-79 and octogenarians that pursued palliative care had higher rates of 30-day and 90-day mortality. Nonagenarians did not experience the same outcome and had no difference in 30-day and 90-day mortality whether they pursued palliative care or not.

Conclusion/Discussion: These findings highlight significant age-related differences in treatment decisions and may reflect appropriately individualized care in the context of increasingly medically complex or frail patients. The lack of difference in mortality in nonagenarians whether or not palliative care was pursued questions whether pursuing aggressive treatment in this population is warranted.

Table 1
Comparison of clinical stage and treatment decisions between patients aged 65-79 years old, octogenarians, and nonagenarians
Table 2.
Comparison of 30- and 90-day mortality in patients who did and did not receive palliative care.