br Results br Population Demographics br The cohort consiste
3.1. Population Demographics
The cohort consisted of a total of 1361 patients with colon cancer, 683 (50.2%) of whom were aged 70 or older. The median age at diagno-sis was 70, with an interquartile range (IQR) of 62–76 years. In the younger group, the median age was 62 (IQR, 57–66 years) whereas the older group's median age was 76 (IQR, 73–80 years). Of the 683 pa-tients in the older group, 168 (24.6%) were over the age of 80. There were no statistically significant differences in demographics or baseline tumour characteristics between the two age groups. Additional demo-graphic characteristics are summarized in Table 1.
3.2. Receipt of Chemotherapy
Treatments received are also described in Table 1. In the entire co-hort, 1013 (74.4%) patients received adjuvant chemotherapy, of whom 504 (49.8%) received single agent and 509 (50.2%) received combina-tion regimens. In an age-group comparison, younger patients were sig-nificantly more likely to receive adjuvant chemotherapy than older patients (89.7% vs. 59.3%, p b 0.0001). Among the 1013 patients who Okadaic acid had received chemotherapy, 66% of younger patients had received com-bination therapy while only 26% of older patients had received combi-nation therapy (p b 0.0001).
In the younger patient cohort 3 year RFS recurrence free survival was
Comparing the older group of deceased patients to the younger
Basic demographic characteristics.
group, those who were young were significantly more likely to die
colon cancer deaths, younger patients were significantly more likely to
3.5. Analysis and Predictors of Death in Patients Aged 70 and Above
In older patients who received chemotherapy, 168 out of 405 pa-
(72%) of patients who did not receive chemotherapy died in the fol-
low-up period. Within the cohort of older patients who died (n =
369), those who received chemotherapy were more likely to die from
remained the most common cause of death in patients who did not re-
ceive chemotherapy. (Table 3). Among patients who received chemo-
the follow-up period, with cardiac disease being the most common
not offered chemotherapy died of colon cancer. r> In the older patient cohort, we collected additional clinical data
(Table 4) to analyze predictors of causes of death (colon cancer versus
non-colon cancer). In an exploratory analysis -presence of one or
more comorbidities (congestive heart failure, previous cancer, COPD,
coronary artery disease) was inversely associated with death from
colon cancer. Another primary cancer also predictive of non-colon can-
cancer versus non-colon cancer death in the older patient cohort using
demographic and tumour factors. These included stage (IIIA vs IIIB vs
stage was associated with colon cancer death (p = 0.0315). Absence of
chemotherapy was also associated with colon cancer death (p =
3.4. Causes of Death for Whole Cohort
Causes of death are summarized in Table 2. Of the 601 patients in the To our knowledge, this is the first study to date to detail the causes of
patients had a documented recurrence of their colon cancer after cura- death in a population-based cohort of adults with stage 3 colon cancer.
tive surgery. 169 (28.1%) died of non-colon cancer causes and 15 had The strength of our database and the detailed review of medical records
unknown cause of death. Among the non-colon cancer deaths, other allowed us to capture causes of death that may have been misclassified
primary cancers (46; 27.2%), cardiac disease including myocardial in- when simply using data obtained from death certificates. This study un-
farction and heart failure (45; 26.6%), neurologic disorder which in- derscores the fact that older patients remain under-treated with che-
cludes dementia and other neurogenerative diseases (18; 10.7%), motherapy relative to their younger counterparts. We also
strokes (14; 8.3%), and infections (11, 6.5%) were the most prevalent demonstrate that older patients were likely to die from non-colon can-
causes of death. Death that could be ascribed directly to receipt of che- cer causes, such as heart disease and neurologic events.
motherapy occurred in 2 patients, both of whom had aspiration pneu- Multiple large studies have demonstrated that older patients derive
monia. These were categorized as “other”.
similar benefit from adjuvant chemotherapy compared to younger pa-