Trends in the management and survival of digestive tract cancers among patients aged over 80 years

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Abstract
Background: Advances have occurred in the management of digestive tract cancers, but it is not known how much they have benefited the elderly. Aims: To determine trends in treatment, stage at diagnosis and prognosis of digestive tract cancers among patients aged ≥80 years in two well-defined French populations. Design: Time trends were studied in three age classes and in 5 four-year time intervals. A multivariate relative survival analysis was performed to estimate the independent effect of both age and period on prognosis. Results: Five-year relative survival rates were 1.9% for oesophageal cancer, 12% for stomach cancer, 41% for colon cancer and 37% for rectal cancer. The survival rates improved between the first and the fifth period for all cancer sites except for oesophageal cancer. This improvement remained significant after adjustment for age, sex, site and treatment. It was associated with an increase in the proportion of patients who underwent curative resection. Very few patients received adjuvant chemotherapy. The use of adjuvant radiotherapy for rectal and oesophageal cancers did not significantly increase over time. Conclusions: Except for oesophageal cancers, substantial advances in the care of digestive tract cancers in the elderly have been achieved. Surgery should not be restricted on the basis of age alone. Further improvements can be made in particular to enhance adjuvant therapy whenever possible.