Caring for Octogenarian and Nonagenarian Patients with Colorectal Cancer: What Should Our Standards and Expectations Be?

Purpose: Octogenarians and nonagenarians constitute a rapidly growing segment of patients undergoing colorectal cancer resection. We describe their outcomes in a large population cohort and aim to establish expectations and improvements for their care.

Methods: All patients undergoing surgical resection for colorectal cancer in California (1994-2005) were identified in the California Cancer Registry, which was linked with the California Office of Statewide Health Planning and Development Patient Discharge Database and the 2000 United States Census. Multivariate logistic regression was used to determine significant outcome predictors.

Results: Octogenarians and nonagenarians comprised 26% of all patients undergoing colon cancer resection and 16% of all patients undergoing rectal cancer resection from 1994 to 2005. This cohort had more comorbidities but less distant disease than patients <65 years old (P < .001). Twelve percent of patients with rectal cancer and 17% of patients with colon cancer who were 80 years or older had emergent surgery vs 5% and 12%, respectively, for patients <65 years old (P < .001). Patients 80 years or older had nearly twice the readmission incidence rate (417 readmissions per thousand patient-years) of patients <65 years old. Twenty-seven percent of 90-day readmissions were for surgical complications, 52% of which required a subsequent procedure. Patients 80 years or older had high in-hospital mortality (6%) and one-year mortality (29%). Medical complications, increasing comorbidities, and cancer stage were predictive of in-hospital and 1-year mortality.

Conclusions: : Octogenarians and nonagenarians represent a large segment of patients with colorectal cancer undergoing surgical resection with high rates of morbidity, mortality, and readmission. Medical optimization and excellent continuity of care may contribute to improved outcomes following surgery for these complex patients.