The effects of age and comorbidity on treatment patterns for radiotherapy and survival in patients with mobile rectal cancer: A population-based study
Purpose: To describe treatment patterns and outcome for short-course preoperative radiotherapy in patients with mobile rectal cancer according to age and comorbidity. Patients and methods: All 914 patients, aged ≥ 50 years, with T2-T3, N0-2, M0 rectal cancer, newly diagnosed in Southern Netherlands between 2002 and 2006 were included. The influence of age, patient and tumour characteristics and type of surgery on treatment with 5 × 5 Gy preoperative radiotherapy and survival was analysed. Results: Patients younger than 70 years received radiotherapy less frequently if they had multiple comorbid conditions (OR = 0.4), a history with previous cancer (OR = 0.2) or had undergone low anterior resection (OR = 0.5). Among patients aged 70 years or older, men received radiotherapy more often than women (OR = 2.0) and withholding radiotherapy was associated with multiple comorbid conditions (OR = 0.3), low anterior resection (OR = 0.3), diabetes mellitus (OR = 0.5) or age above 80 years (OR = 0.5). Among patients ≥ 70 years old, hazard ratios for death were increased for males (HR = 1.5), higher age (HR = 1.06 per year of age), multiple comorbidities (HR = 1.7) and pulmonary disease (HR = 1.6) independently. Receiving radiotherapy had no significant influence on survival after adjustment for other prognostic variables. Conclusions: Withholding short-course preoperative radiotherapy depends on age only in patients aged 70 years or older. As a rule, factors that predict life expectancy, determine also the decision to withheld preoperative radiotherapy. With the exception that women receive radiotherapy less frequently as compared to men, although women survive longer.