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Optimizing Colorectal Cancer Care in Older Patients

  • Personalized Medicine in Colorectal Cancer (D Cunningham and EC Smyth, Section Editors)
  • Published:
Current Colorectal Cancer Reports

Abstract

Colorectal cancer is a disease affecting mainly older people, a fact that is becoming more apparent with the global population aging. However, this patient group is more likely to be subjected to suboptimal treatment due to a number of factors, but most commonly as a result of the physician’s weakness to recognize those fit for the full spectrum of cancer therapy. In this regard, clinical screening tests, such as the Comprehensive Geriatric Assessment, can be invaluable in guiding treatment decisions. Fluoropyrimidine-based adjuvant chemotherapy clearly confers a survival advantage in older individuals with node-positive disease; however, the benefit from the administration of oxaliplatin-based regimens is less clear. Palliative chemotherapy also has an important role in managing metastatic disease, and with the use of novel targeted agents it can potentially prolong survival and improve quality of life. The management of rectal cancer in this population can present a challenge, since it appears that the optimal treatment of chemoradiation followed by total mesorectal excision can be applied in select few. Indeed, the morbidity and mortality rates in older people treated with these combined modalities can be too high, guiding many physicians to opt for more conservative approaches, directed at providing palliation and local control, especially in those with limited life expectancy. In conclusion, in order to provide the best care in an older colorectal cancer patient, we need to individualize our approach, selecting the right patient for the right treatment.

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  1. Department of Medical Oncology, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Strovolos 2006, Nicosia, Cyprus

    Stavros Gkolfinopoulos, Panteleimon Kountourakis & Demetris Papamichael

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Correspondence to Stavros Gkolfinopoulos, Panteleimon Kountourakis or Demetris Papamichael.

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Stavros Gkolfinopoulos declares that he has no conflict of interest.

Panteleimon Kountourakis declares that he has no conflict of interest.

Demetris Papamichael has participated on advisory boards and has lectured at scientific events organized by Amgen, Roche, and Merck.

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This article is part of the Topical Collection on Personalized Medicine in Colorectal Cancer

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Gkolfinopoulos, S., Kountourakis, P. & Papamichael, D. Optimizing Colorectal Cancer Care in Older Patients. Curr Colorectal Cancer Rep 12, 9–17 (2016). https://doi.org/10.1007/s11888-016-0304-y

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