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Author Notes:

Corresponding Author: Richard J. Cassidy, MD, Radiation Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, 1365 Clifton Road NE, Atlanta, GA 30322, richardjcassidy@gmail.com, Cell: 904-790-9207, Fax: 1-888-971-2304.

Author contributions: RJC (all aspects), JMS (data collection, statistical analysis), EC (data collection, statistical analysis), RJ (data collection), JJ (planning, review), KP (planning, review), DGT (planning, review), MCR (planning, review), CES (planning, review), TWG (planning, data collection, editing, review), MWD (planning, review), JCL (all aspects)

Conflicts of Interest/Disclosures: None


Research Funding:

This work was supported by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and National Cancer Institute at the National Institute of Health (Grant Number P30CA138292).

This funding supported the statisticians who helped with study design, performed the analysis and helped with data interpretation.

This funding did not have any role in the writing of the manuscript or the decision to submit it for publication.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The data used in the study are derived from a de-identified NCDB file.

The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • chemotherapy and radiation therapy
  • geriatric oncology
  • health care disparities
  • rectal cancer
  • total mesorectal excision

Health Care Disparities Among Octogenarians and Nonagenarians With Stage II and III Rectal Cancer

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Journal Title:



Volume 123, Number 22


, Pages 4325-4336

Type of Work:

Article | Post-print: After Peer Review


BACKGROUND: Octogenarians and nonagenarians with stage II/III rectal adenocarcinomas are underrepresented in the randomized trials that have established the standard-of-care therapy of preoperative chemoradiation followed by definitive resection (ie, chemoradiation and then surgery [CRT+S]). The purpose of this study was to evaluate the impact of therapies on overall survival (OS) for patients with stage II/III rectal cancers and determine predictors of therapy within the National Cancer Data Base (NCDB). METHODS: In the NCDB, patients who were 80 years old or older and had clinical stage II/III rectal adenocarcinoma from 2004 to 2013 were queried. Kaplan-Meier analysis, log-rank testing, logistic regression, Cox proportional hazards regression, interaction effect testing, and propensity score–matched analysis were conducted. RESULTS: The criteria were met by 2723 patients: 14.9% received no treatment, 29.7% had surgery alone, 5.0% underwent short-course radiation and then surgery (RT+S), 45.3% underwent CRT+S, and 5.1% underwent surgery and then chemoradiation (S+CRT). African American race and residence in a less educated county were associated with not receiving treatment. Male sex, older age, worsening comorbidities, and receiving no treatment or undergoing surgery alone were associated with worse OS. There was no statistical difference in OS between RT+S, S+CRT, and CRT+S. Interaction testing found that CRT+S improved OS independently of age, comorbidity status, sex, race, and tumor stage. In the propensity score–matched analysis, CRT+S was associated with improved OS in comparison with surgery alone. CONCLUSIONS: A significant portion of octogenarians and nonagenarians with stage II/III rectal adenocarcinomas do not receive treatment. African American race and living in a less educated community are associated with not receiving therapy. This series suggests that CRT+S is a reasonable strategy for elderly patients who can tolerate therapy. Cancer 2017;123:4325-36. © 2017 American Cancer Society.

Copyright information:

© 2017 American Cancer Society

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