Highlights
- •Screening guidelines for colorectal cancer have yet to be established in patients greater than 75 years of age.
- •Patients greater 75 years who underwent colonoscopy for symptomatic colon cancer had a low mortality.
- •Utilizing frailty indices to identify screening patterns for patients beyond 75 years could prove beneficial.
Abstract
Introduction
Colorectal cancer screening improved outcomes for patients diagnosed between the age
of 45-75. Present life expectancy is beyond this limit, yet there are no guidelines
for these ages. We aim to identify outcomes after screening and intervention in patients
≥75 years and correlate with frailty.
Materials and methods
Records between 2011 and 2019 were queried. Patients ≥75 screened and treated for
colorectal cancer were included. Patient demographics, perioperative mortality, age
at last colonoscopy and frailty score were calculated. A Modified Frailty Index from
the Canadian Study of Health and Aging Frailty Index was used. A score of 1 to 11
was calculated based on patient comorbidities. The MFI was assigned from 0 to 11:
0 signified absence of frailty and 11 indicated maximum frailty.
Results
Of 179 patients were identified, 46.3% males. 171(95%) had elective and 8 (5%) had
emergent surgery. The average age was 81.8 years. All colonoscopies were performed
for symptoms. A modified frailty index was retrospectively calculated; 75% of patients
scored between 0 and 2 and 1% scored >6.
Conclusion
Older patients who underwent colonoscopy and surgery for symptomatic colon cancer
had a low mortality, 2%. The average age was 6.8 years older than the recommended
cutoff for colonoscopy screening. Most patients scored 0 to 2 on the modified frailty
index, suggesting that not only are older patients more fit than previously thought,
but also able to tolerate colorectal interventions more liberally. Utilizing frailty
indices to identify screening patterns beyond 75 years of age might prove beneficial
for this patient population. Further studies are recommended.
Keywords
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References
US Preventive Services Task Force. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(23): 25642575. doi:10.1001/jama.2016.5989.
Colorectal Cancer Screening and Surveillance: Clinical Guideline and Rationale. 2021.
USCS Data Visualizations. Available at: https://gis.cdc.gov/grasp/USCS/DataViz.html. Accessed July 26, 2020.
- Surveillance colonoscopy in elderly patients: a retrospective cohort study.JAMA Inter Med. 2014; 174: 1675-1682https://doi.org/10.1001/jamainternmed.2014.3746
- Laparoscopic colectomy in the elderly: when is too old?.Clin Colon Rectal Surg. 2006; 19: 33-39https://doi.org/10.1055/s-2006-939529
“Census Profile: Montgomery County, PA.” Census Reporter, http://censusreporter.org/profiles/05000US42091-montgomery-county-pa/. Accessed July 23, 2020.
- A global clinical measure of fitness and frailty in elderly people.CMAJ. 2005; 173: 489-495https://doi.org/10.1503/cmaj.050051
- Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database.J Surg Res. 2020; (Available at:) (Accessed July 19, 2020)
- Laparoscopic colectomy in octogenarians and nonagenarians: a preferable option to open surgery?.J Surg Educ. 2010; 67: 161-166https://doi.org/10.1016/j.jsurg.2010.02.009
- In-hospital and 6-month mortality rates after open elective vs open emergent colectomy in patients older than 80 years.Dis Colon Rectum. 2011; 54: 467-471https://doi.org/10.1007/DCR.0b013e3182060904
- Systematic review of laparoscopic vs open surgery for colorectal cancer in elderly patients.World J Gastrointest Oncol. 2016; 8: 573-582https://doi.org/10.4251/wjgo.v8.i7.573
- Personalizing colonoscopy screening for elderly individuals based on screening history, cancer risk, and comorbidity status could increase cost effectiveness.Gastroenterol. 2015; 149: 1425-1437https://doi.org/10.1053/j.gastro.2015.07.042
- Colorectal cancer initial diagnosis: screening colonoscopy, diagnostic colonoscopy, or emergent surgery, and tumor stage and size at initial presentation.Clin Colorectal Cancer. 2016; 15: 67-73
- Treatment of Colorectal Cancer in Older Patients: International Society of Geriatric Oncology (SIOG) Consensus Recommendations 2013.Ann Oncol. 2015; 26: 463-476https://doi.org/10.1093/annonc/mdu253
- Frailty identified by geriatric assessment is associated with poor functioning, high symptom burden and increased risk of physical decline in older cancer patients: prospective observational study.Palliat Med. 2019; 33: 312-322https://doi.org/10.1177/0269216319825972
- Frailty and cancer: implications for oncology surgery, medical oncology, and radiation oncology.CA Cancer J Clin. 2017; 67: 362-377https://doi.org/10.3322/caac.21406
Article info
Publication history
Published online: November 28, 2021
Accepted:
November 22,
2021
Received:
March 28,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
