Management and survival of colorectal cancer in the elderly in population-based studies

Published:September 28, 2007DOI:


      Colorectal cancer is a major problem in elderly patients. Most data on the management and survival of colorectal cancer has been provided by specialised hospital units and as such cannot be used as reference because of unavoidable selection bias. Cancer registries recording data on treatment and survival at a population level represent the best valuable resource to assess the management of patients. However, there is a paucity of reports published in the literature due to the difficulty to routinely collect such data. Relative survival rates in the elderly were lower than in younger patients. However, the gap that has separated younger from elderly patients is closing. Stage at diagnosis remains the major determinant of prognosis. There is also large variation in survival within countries: survival rates being dramatically lower in Eastern European countries, compared to Western European countries. Comorbidity, which is particularly frequent in the elderly, increases the complexity of cancer management and affects survival. Substantial improvement in the care of colorectal cancer in the elderly has been achieved (increase in the proportion of patients resected for cure, decrease in operative mortality, improvement in stage at diagnosis). Surgery should not be restricted on the basis of age alone. Further improvements can be made, in particular with respect to adjuvant therapy.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Parkin MD, Whelan SL, Ferlay J, Teppo L, Thomas DB. Cancer incidence in five continents, vol VIII, IARC Scientific Publications n°155, Lyon, 2002.

        • Mitry E.
        • Bouvier A.M.
        • Esteve J.
        • Faivre J.
        Improvement in colorectal cancer survival: a population-based study.
        Eur J Cancer. 2005; 4: 2297-2303
        • Hakulinen T.
        Cancer survival corrected for heterogeneity in patient withdrawal.
        Biometrics. 1982; 38: 933-942
        • Colorectal Cancer collaborative Group
        Surgery for colorectal cancer in elderly patients : a systematic review.
        Lancet. 2000; 356: 968-974
        • Bouvier A.M.
        • Launoy G.
        • Lepage C.
        • Faivre J.
        Trends in the management and survival of digestive tract cancers among patients aged over 80 years.
        Aliment Pharmacol Ther. 2005; 22: 233-241
        • Bouhier K.
        • Maurel J.
        • Lefevre H.
        • Bouin M.
        • Arsene D.
        • Launoy G.
        Changes practices for diagnosis and treatment of colorectal cancer in Calvados : 1990-1999.
        Gastroenterol Clin Biol. 2004; 28: 371-376
        • Faivre-Finn C.
        • Bouvier-Benhamiche A.M.
        • Phelip J.M.
        • ManfrediI S.
        • Dancourt V.
        • Faivre J.
        Colon cancer in France: evidence for improvement in management and survival.
        Gut. 2002; 51: 60-64
        • Iversen L.H.
        • Pedersen L.
        • Riis A.
        • Friis S.
        • Laurberg S.
        • Sorensen H.T.
        Age and colorectal cancer with focus on the elderly : trends in relative survival and initial treatment from a Danish population-based study.
        Dis Colon Rectum. 2005; 48: 1755-1763
        • Lemmens V.E.P.P.
        • Janssen-Heijnen M.L.
        • Verheij C.D.
        • Houterman S.
        • Repelaer van Driel O.J.
        • Coebergh J.W.
        Co- morbidity leads to altered treatment and worse survival of elderly patients with colorectal cancer.
        Br J Surg. 2005; 92: 615-623
        • Arveux I.
        • Boutron M.C.
        • El Mrini T.
        • et al.
        Colon cancer in the elderly : evidence for major improvements in health care and survival.
        Br J Cancer. 1997; 76: 963-967
        • Masracci T.M.
        • Hendren S.
        • O’Connor B.
        • Mc Leod R.S.
        The impact of surgery for colorectal cancer on quality of life and functional status in the elderly.
        Dis Colon Rectum. 2006; 49: 1878-1884
        • Gross C.P.
        • Guo Z.
        • Mc Avay G.J.
        • Allore H.G.
        • Young M.
        • Tinetti M.E.
        Multimorbidity and survival in older persons with colorectal cancer.
        J Am Geriatr Soc. 2006; 54: 1898-1904
        • Lemmens V.E.P.P.
        • Janssen-Heijnen M.L.G.
        • Houterman S.
        • et al.
        Which comorbid conditions predict complications after surgery for colorectal cancer?.
        World J Surg. 2007; 31: 192-199
        • Moertel C.G.
        • Fleming T.R.
        • Mac Donald J.S.
        • et al.
        Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma.
        New Engl J Med. 1990; 322: 352-358
        • Faivre-Finn C.
        • Bouvier A.M.
        • Mitry E.
        • Rassiat E.
        • Clinard F.
        • Faivre J.
        Chemotherapy for colon cancer in a well- defined French population: is it under- or over-prescribed?.
        Aliment Pharmacol Ther. 2002; 16: 353-359
        • Lemmens V.E.P.P.
        • van Halteren A.H.
        • Janssen-Heijnen M.L.
        • Vreugdenhil G.
        • Repelaer van Driel O.J.
        • Coebergh J.W.
        Adjuvant treatment for elderly patients with stage III colon cancer in the southern Netherlands is affected by socioeconomic status, gender, and comorbidity.
        Ann Oncol. 2005; 16: 767-772
        • Bouchardy C.
        • Queneau P.E.
        • Fioretta G.
        • et al.
        Adjuvant chemotherapy for colon carcinoma with positive lymph nodes : use and benefit in routine health care practice.
        Br J Cancer. 2001; 85: 1251-1257
        • Morris M.
        • Platell C.
        • Fritschi L.
        • Iacopetta B.
        Failure to complete adjuvant chemotherapy is associated with adverse survival in stage III colon cancer patients.
        Br J Cancer. 2007; 96: 701-707
        • Phelip J.M.
        • Grosclaude P.
        • Launoy G.
        • et al.
        Are there regional differences in the management of colon cancer in France?.
        Eur J Cancer Prev. 2005; 14: 31-37
        • Fietkau R.
        • Zettl H.
        • Klocking S.
        • Kundt G.
        Incidence, therapy and prognosis of colorectal cancer in different age groups.
        Strahlenther Onkol. 2004; 180: 478-487
        • Potosky A.L.
        • Harlan L.C.
        • Kaplan R.S.
        • Johson K.A.
        • Lynch C.F.
        Age, sex and racial differences in the use of standard adjuvant therapy for colorectal cancer.
        J Clin Oncol. 2002; 20: 1192-1202
        • Schrag D.
        • Cramer L.D.
        • Bach C.B.
        • Begg P.B.
        Age and adjuvant chemotherapy use after surgery for stage III colon cancer.
        JNCI. 2001; 93: 850
        • Dobie S.A.
        • Baldwin L.M.
        • Dominitz J.A.
        • Matthews B.
        • Billingskey K.
        • Barlow W.
        Completion of therapy by Medicare patients with stage III colon cancer.
        J Natl Cancer Inst. 2006; 98: 610-619
        • Sundararajan V.
        • Grann V.R.
        • Jacobson J.S.
        • et al.
        Variations in the use of adjuvant chemotherapy for node-positive colon cancer in the elderly: a population-based study.
        Cancer J. 2001; 7: 213
        • Ayanian J.Z.
        • Zaslavsky A.M.
        • Fuchs C.S.
        • et al.
        Use of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort.
        J Clin Oncol. 2003; : 1293-1300
        • Neugut A.I.
        • Matasar M.
        • Wang X.
        • et al.
        Duration of adjuvant chemotherapy for colon cancer and survival among the elderly.
        J Clin Oncol. 2006; 24: 2368-2375
        • Cronin D.P.
        • Harlan L.C.
        • Potosky A.L.
        • Clegg L.X.
        • Stevens J.L.
        • Mooney M.M.
        Patterns of care for adjuvant therapy in a random population-based sample of patients diagnosed with colorectal cancer.
        Am J Gastroenterol. 2006; 101: 2308-2318
        • Gross C.P.
        • McAvay G.J.
        • Guo Z.
        • Tinetti M.E.
        The impact of chronic illnesses on the use and effectiveness of adjuvant chemotherapy for colon cancer.
        Cancer. 2007; 109: 2410-2419
        • Jessup M.
        • Stewart A.
        • Greene F.L.
        • Minsky B.D.
        Adjuvant chemotherapy for stage III colon cancer : implications of race, ethnicity, age and differentiation.
        JAMA. 2005; 294: 2703-2711
        • Sundararajan V.
        • Mitra N.
        • Jacobson J.S.
        • Grann V.R.
        • Meitjan D.F.
        • Neugut A.I.
        Survival associated with 5-FU-based adjuvant chemotherapy among elderly patients with node-positive colon cancer.
        Ann Inter Med. 2002; 136: 349-357
        • Sargent D.J.
        • Goldberg R.M.
        • Jacobson S.D.
        • et al.
        A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients.
        N Engl J Med. 2001; 345: 1091-1097
        • Kohne C.H.
        • Grothey A.
        • Bokemeyer C.
        • Barthke N.
        • Aapro M.
        Chemotherapy in elderly patients with colorectal cancer.
        Ann Oncol. 2001; 12: 435-442
        • Yellen S.B.
        • Cella D.F.
        • Leslie W.T.
        Age and clinical decision making in oncology patients.
        J Natl Cancer Inst. 1994; 86: 1766-1770
        • Newcomb P.A.
        • Carbone P.P.
        Cancer treatment and age : patient perspectives.
        J Natl Cancer Inst. 1993; 85: 1580-1584
        • Bouvier A.M.
        • Bauvin E.
        • Danzon A.
        • et al.
        Place of multidisciplinary consulting meetings and clinical trials in the management of colorectal cancer in France in 2000.
        Gastroenterol Clin Biol. 2007; 31: 286-291
        • Manfredi S.
        • Bouvier A.M.
        • Lepage C.
        • Hatem C.
        • Dancourt V.
        • Faivre J.
        Incidence and patterns of recurrence after resection for cure of colonic cancer in a well defined population.
        Br J Surg. 2006; 93: 1115-1122
        • Kapiteijn E.
        • Marijnen C.A.
        • Nagtegaal I.D.
        • et al.
        Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer.
        N Engl J Med. 2001; 34: 638-646
        • Faivre-Finn C.
        • Benhamiche A.M.
        • Maingon P.
        • Janoray P.
        • Faivre J.
        Changes in the practice of adjuvant radiotherapy in resectable rectal cancer within a French well-defined population.
        Radiother Oncol. 2000; 57: 137-142
        • Neugut A.I.
        • Fleischauer A.T.
        • Sundararajan V.
        • et al.
        Use of adjuvant chemotherapy and radiation therapy for rectal cancer among the elderly: a population-based study.
        J Clin Oncol. 2002; 20: 2643-2650
        • Martijn H.
        • Voogd A.C.
        • van de Poll-Franse L.V.
        • Repelaer van Driel O.J.
        • Rutten H.J.
        • Coebergh J.W.
        Colorectal Cancer Study Group of the Comprehensive Cancer Centre South (IZK). Improved survival of patients with rectal cancer since 1980: a population-based study.
        Eur J Cancer. 2003; 39: 2073-2079
        • Shahir M.A.
        • Lemmens V.E.P.P.
        • van de Poll-Franse L.V.
        • Voogd A.C.
        • Martijn H.
        • Janssen-Heijnen M.L.G.
        Elderly patients with rectal cancer have a higher risk of treatment-related complications and a poorer porognosis than younger patients: a population-based study.
        Eur J Cancer. 2006; 42: 3015-3021
        • Vulto A.J.
        • Lemmens V.E.P.P.
        • Louwman W.J.
        • Janssen-Heijnen M.L.G.
        • Poortmans P.H.
        • Lybeert M.L.
        • et al.
        The influence of age and comorbidity on receiving radiotherapy as part of primary treatment for cancer in South Netherlands, 1995-2002.
        Cancer. 2006; 15: 2734-2742
        • Mitry E.
        • Bouvier A.M.
        • Esteve J.
        • Faivre J.
        Benefit of operative mortality reduction on colorectal cancer survival.
        Br J Surg. 2002; 89: 1557-1562
        • Enblad P.
        • Adami H.O.
        • Bergstrom R.
        • et al.
        Improved survival of patients with cancers of the colon and rectum?.
        J Natl Cancer Inst. 1988; 80: 586-591
        • Berrino F.
        Survival in cancer patients in Europe : the EUROCARE-3 Study.
        Ann Oncol. 2003; 14
        • Quaglia A.
        • Capocaccia R.
        • Micheli A.
        • Carrani E.
        • Vercelli M.
        • A wide difference in cancer survival between middle aged
        • et al.
        • and the EUROCARE-3 working group
        Int J Cancer. 2007; 15: 2196-2201
        • Bossard N.
        • Velten M.
        • Remontet L.
        • et al.
        Survival of cancer patients in France : a population-based study from the Association of the French Cancer Registries.
        Eur J Cancer. 2007; 43: 149-160
        • Monnet E.
        • Faivre J.
        • Raymond L.
        • et al.
        Influence of stage at diagnosis on survival differences for rectal cancer in three European populations.
        Br J Cancer. 1999; 81: 463-468
        • Micheli A.
        • Coebergh J.W.
        • Mugno E.
        • et al.
        European health system and cancer care.
        Ann Oncol. 2003; 14: v41-v60
      2. Martijn H, Vulto JCM. Should radiotherapy be avoided or delivered differently in elderly patients with rectal cancer? Eur J Cancer [in this issue].