Page 182 - Risk quantification and modification in older patients with colorectal cancer

Chapter 9
Table 1 Patient demographics
Male (%)
Median age in years (range)
Number of patients with charlson Comorbidity Index ≥ 2 (%) Polypharmacy (use of ≥5 medications) (%)
Tumour location (%) colon
rectum
Tumour stage (%) I
II III IV
Treatment decisions
Total (n=168) 86 (51%)
81 (60-94) 75 (45%) 115 (69%)
118 (71%) 49 (29%)
13 (9%) 30 (21%) 70 (49%) 31 (22%)
Of the 139 cases that had a geriatric consultation because of uncertainty regarding the treatment plan, the geriatrician recommended the ‘more intensive treatment’ option in 96 cases (69%) and the ‘less intensive treatment’ option in 43 cases (31%, Figure 1). Of the latter, ‘supportive care only’ was recommended in 27 cases (63%), 50% of these patients had stage IV cancer.
For 45 of the 139 patients (32%) the recommendation differed from the treatment plan of the referring specialist. The alternative plan suggested by the geriatrician for these 45 patients, was accepted for 34 patients (76%) while for 9 patients (20%), the initial plan was maintained. The remaining two (4%) patients opted out of treatment themselves. Treatment suggestions following geriatric consultation were not different between the age groups <80 years, 80-84 years and ≥85 years (p=0.61). For patients with ≥3 impaired geriatric domains, ‘more intensive treatment’ was recommended significantly less often while ‘less intensive treatment’ was recommended more often (in 54% and 46% respectively in patients with ≥3 domains compared to 80% and 20% respectively of those with <3 domains, p=0.001).
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