Current Treatment Options in Gastroenterology

, Volume 12, Issue 3, pp 269–282

Colorectal Cancer of the Elderly

Geriatrics (S Katz, Section Editor)

Opinion statement

Colorectal cancer (CRC) disproportionately affects the elderly. Older age is a strong risk factor for both the development of precancerous adenomas and CRC, thus raising the issue of screening and surveillance in older patients. However, screening and surveillance decisions in the elderly can be complex and challenging. Elderly patients are a diverse and heterogeneous group and special considerations such as co-morbid medical conditions, functional status, and cognitive ability play a role in one’s decisions regarding the utility of screening and surveillance. Such considerations also play a role in factors related to screening modalities, such as colonoscopy, as well as CRC treatment options and regimens. This review addresses many of the unique factors associated with CRC of the elderly and critically examines many of the controversies and challenges surrounding CRC in older patients.


Colorectal cancer Colonoscopy Screening Surveillance Elderly Very elderly Adverse events Endoscopy Quality 

References and Recommended Reading

  1. 1.
    Howlader N NA, Krapcho M, Garshell J, Neyman N, Altekruse SF, Kosary CL, et al. (eds). SEER Cancer Statistics Review, 1975-2010, National Cancer Institute. Bethesda, MD,, accessed July 20, 2013.
  2. 2.
    Rabeneck L, El-Serag HB, Davila JA, Sandler RS. Outcomes of colorectal cancer in the United States: no change in survival (1986-1997). Am J Gastroenterol. 2003;98:471–7.PubMedGoogle Scholar
  3. 3.
    Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, et al. Genetic alterations during colorectal-tumor development. N Engl J Med. 1988;319:525–32.PubMedGoogle Scholar
  4. 4.
    Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med. 2000;343:162–8.PubMedGoogle Scholar
  5. 5.
    Khullar SK, DiSario JA. Colon cancer screening. Sigmoidoscopy or colonoscopy. Gastrointest Endosc Clin N Am. 1997;7:365–86.PubMedGoogle Scholar
  6. 6.
    Neugut AI, Jacobson JS, De Vivo I. Epidemiology of colorectal adenomatous polyps. Cancer Epidemiol Biomarkers Prev. 1993;2:159–76.PubMedGoogle Scholar
  7. 7.
    Strul H, Kariv R, Leshno M, Halak A, Jakubowicz M, Santo M, et al. The prevalence rate and anatomic location of colorectal adenoma and cancer detected by colonoscopy in average-risk individuals aged 40-80 years. Am J Gastroenterol. 2006;101:255–62.PubMedGoogle Scholar
  8. 8.
    Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF. Results of screening colonoscopy among persons 40 to 49 years of age. N Engl J Med. 2002;346:1781–5.PubMedGoogle Scholar
  9. 9.
    Omata F, Brown WR, Tokuda Y, Takahashi O, Fukui T, Ueno F, et al. Modifiable risk factors for colorectal neoplasms and hyperplastic polyps. Intern Med. 2009;48:123–8.PubMedGoogle Scholar
  10. 10.
    Lieberman DA, Prindiville S, Weiss DG, Willett W. Risk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals. JAMA. 2003;290:2959–67.PubMedGoogle Scholar
  11. 11.
    Johannsen LG, Momsen O, Jacobsen NO. Polyps of the large intestine in Aarhus, Denmark. An autopsy study. Scand J Gastroenterol. 1989;24:799–806.PubMedGoogle Scholar
  12. 12.
    Williams AR, Balasooriya BA, Day DW. Polyps and cancer of the large bowel: a necropsy study in Liverpool. Gut. 1982;23:835–42.PubMedCentralPubMedGoogle Scholar
  13. 13.
    Vatn MH, Stalsberg H. The prevalence of polyps of the large intestine in Oslo: an autopsy study. Cancer. 1982;49:819–25.PubMedGoogle Scholar
  14. 14.
    Singal AK, Rosman AS, Post JB, Bauman WA, Spungen AM, Korsten MA. The renal safety of bowel preparations for colonoscopy: a comparative study of oral sodium phosphate solution and polyethylene glycol. Aliment Pharmacol Ther. 2008;27:41–7.PubMedGoogle Scholar
  15. 15.
    Noshirwani KC, van Stolk RU, Rybicki LA, Beck GJ. Adenoma size and number are predictive of adenoma recurrence: implications for surveillance colonoscopy. Gastrointest Endosc. 2000;51:433–7.PubMedGoogle Scholar
  16. 16.
    Harewood GC, Lawlor GO. Incident rates of colonic neoplasia according to age and gender: implications for surveillance colonoscopy intervals. J Clin Gastroenterol. 2005;39:894–9.PubMedGoogle Scholar
  17. 17.
    Harewood GC, Lawlor GO, Larson MV. Incident rates of colonic neoplasia in older patients: when should we stop screening? J Gastroenterol Hepatol. 2006;21:1021–5.PubMedGoogle Scholar
  18. 18.
    van Heijningen EM, Lansdorp-Vogelaar I, Kuipers EJ, Dekker E, Lesterhuis W, Ter Borg F, et al. Features of adenoma and colonoscopy associated with recurrent colorectal neoplasia based on a large community-based study. Gastroenterology. 2013;144:1410–8.PubMedGoogle Scholar
  19. 19.
    Pohl H, Srivastava A, Bensen SP, Anderson P, Rothstein RI, Gordon SR, et al. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology. 2013;144:74–80 e1.PubMedGoogle Scholar
  20. 20.
    Martinez ME, Baron JA, Lieberman DA, Schatzkin A, Lanza E, Winawer SJ, et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology. 2009;136:832–41.PubMedCentralPubMedGoogle Scholar
  21. 21.
    Saini SD, Kim HM, Schoenfeld P. Incidence of advanced adenomas at surveillance colonoscopy in patients with a personal history of colon adenomas: a meta-analysis and systematic review. Gastrointest Endosc. 2006;64:614–26.PubMedGoogle Scholar
  22. 22.
    Teriaky A, Driman DK, Chande N. Outcomes of a 5-year follow-up of patients with sessile serrated adenomas. Scand J Gastroenterol. 2012;47:178–83.PubMedGoogle Scholar
  23. 23.
    Rex DK, Ahnen DJ, Baron JA, Batts KP, Burke CA, Burt RW, et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol. 2012;107:1315–29. quiz 1314, 1330.PubMedCentralPubMedGoogle Scholar
  24. 24.
    Togashi K, Konishi F, Ozawa A, Sato T, Shito K, Kashiwagi H, et al. Predictive factors for detecting colorectal carcinomas in surveillance colonoscopy after colorectal cancer surgery. Dis Colon Rectum. 2000;43:S47–53.PubMedGoogle Scholar
  25. 25.
    Harris GJ, Church JM, Senagore AJ, Lavery IC, Hull TL, Strong SA, et al. Factors affecting local recurrence of colonic adenocarcinoma. Dis Colon Rectum. 2002;45:1029–34.PubMedGoogle Scholar
  26. 26.
    Makela JT, Laitinen SO, Kairaluoma MI. Five-year follow-up after radical surgery for colorectal cancer. Results of a prospective randomized trial. Arch Surg. 1995;130:1062–7.PubMedGoogle Scholar
  27. 27.
    Trombold J, Farmer RW, McCafferty M. The impact of colorectal cancer screening in a veteran hospital population. Am Surg. 2013;79:296–300.PubMedGoogle Scholar
  28. 28.
    Bat L, Pines A, Shemesh E, Levo Y, Zeeli D, Scapa E, et al. Colonoscopy in patients aged 80 years or older and its contribution to the evaluation of rectal bleeding. Postgrad Med J. 1992;68:355–8.PubMedCentralPubMedGoogle Scholar
  29. 29.
    Faivre J, Dancourt V, Lejeune C, Tazi MA, Lamour J, Gerard D, et al. Reduction in colorectal cancer mortality by fecal occult blood screening in a French controlled study. Gastroenterology. 2004;126:1674–80.PubMedGoogle Scholar
  30. 30.
    Hardcastle JD, Chamberlain JO, Robinson MH, Moss SM, Amar SS, Balfour TW, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348:1472–7.PubMedGoogle Scholar
  31. 31.
    Kronborg O, Fenger C, Olsen J, Jorgensen OD, Sondergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348:1467–71.PubMedGoogle Scholar
  32. 32.
    Lindholm E, Brevinge H, Haglind E. Survival benefit in a randomized clinical trial of faecal occult blood screening for colorectal cancer. Br J Surg. 2008;95:1029–36.PubMedGoogle Scholar
  33. 33.
    Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med. 1993;328:1365–71.PubMedGoogle Scholar
  34. 34.
    Quintero E, Castells A, Bujanda L, Cubiella J, Salas D, Lanas A, et al. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med. 2012;366:697–706.PubMedGoogle Scholar
  35. 35.
    Atkin WS, Edwards R, Kralj-Hans I, Wooldrage K, Hart AR, Northover JM, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet. 2010;375:1624–33.PubMedGoogle Scholar
  36. 36.
    Segnan N, Senore C, Andreoni B, Arrigoni A, Bisanti L, Cardelli A, et al. Randomized trial of different screening strategies for colorectal cancer: patient response and detection rates. J Natl Cancer Inst. 2005;97:347–57.PubMedGoogle Scholar
  37. 37.
    Schoen RE, Pinsky PF, Weissfeld JL, Yokochi LA, Church T, Laiyemo AO, et al. Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy. N Engl J Med. 2012;366:2345–57.PubMedCentralPubMedGoogle Scholar
  38. 38.
    Zauber AG, Winawer SJ, O'Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366:687–96.PubMedCentralPubMedGoogle Scholar
  39. 39.
    Robertson DJ, Greenberg ER, Beach M, Sandler RS, Ahnen D, Haile RW, et al. Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology. 2005;129:34–41.PubMedGoogle Scholar
  40. 40.
    Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008;149:627-37.Google Scholar
  41. 41.
    Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134:1570–95.PubMedGoogle Scholar
  42. 42.
    Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104:739–50.PubMedGoogle Scholar
  43. 43.
    Joseph DA, King JB, Miller JW, Richardson LC. Prevalence of colorectal cancer screening among adults–Behavioral Risk Factor Surveillance System, United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;61(Suppl):51–6.PubMedGoogle Scholar
  44. 44.
    Kahi CJ, Myers LJ, Slaven JE, Haggstrom D, Pohl H, Robertson DJ, et al. Lower endoscopy reduces colorectal cancer incidence in older individuals. Gastroenterology. 2014;146:718–725 e3.PubMedGoogle Scholar
  45. 45.
    Day LW, Walter LC, Velayos F. Colorectal cancer screening and surveillance in the elderly patient. Am J Gastroenterol. 2011;106:1197–206. Important review that examines the factors unique to colorectal cancer and performing colonoscopy in older adults.PubMedGoogle Scholar
  46. 46.
    Travis AC, Pievsky D, Saltzman JR. Endoscopy in the elderly. Am J Gastroenterol. 2012;107:1495–501. quiz 1494, 1502.PubMedGoogle Scholar
  47. 47.
    Jafri SM, Monkemuller K, Lukens FJ. Endoscopy in the elderly: a review of the efficacy and safety of colonoscopy, esophagogastroduodenoscopy, and endoscopic retrograde cholangiopancreatography. J Clin Gastroenterol. 2010;44:161–6.PubMedGoogle Scholar
  48. 48.
    Early DS, Acosta RD, Chandrasekhara V, Chathadi KV, Decker GA, Evans JA, et al. Modifications in endoscopic practice for the elderly. Gastrointest Endosc. 2013;78:1–7. This article describes in detail the changes to practice that providers should consider when performing endoscopy in elderly patients.PubMedGoogle Scholar
  49. 49.
    Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215:453–66.PubMedGoogle Scholar
  50. 50.
    Ko CW, Riffle S, Shapiro JA, Saunders MD, Lee SD, Tung BY, et al. Incidence of minor complications and time lost from normal activities after screening or surveillance colonoscopy. Gastrointest Endosc. 2007;65:648–56.PubMedGoogle Scholar
  51. 51.
    Day LW, Kwon A, Inadomi JM, Walter LC, Somsouk M. Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc. 2011;74:885–96.PubMedCentralPubMedGoogle Scholar
  52. 52.
    Cooper GS, Kou TD, Rex DK. Complications following colonoscopy with anesthesia assistance: a population-based analysis. JAMA Intern Med. 2013;173:551–6.PubMedCentralPubMedGoogle Scholar
  53. 53.
    Beloosesky Y, Grinblat J, Weiss A, Grosman B, Gafter U, Chagnac A. Electrolyte disorders following oral sodium phosphate administration for bowel cleansing in elderly patients. Arch Intern Med. 2003;163:803–8.PubMedGoogle Scholar
  54. 54.
    Caswell M, Thompson WO, Kanapka JA, Galt DJ. The time course and effect on serum electrolytes of oral sodium phosphates solution in healthy male and female volunteers. Can J Clin Pharmacol. 2007;14:e260–74.PubMedGoogle Scholar
  55. 55.
    Russmann S, Lamerato L, Marfatia A, Motsko SP, Pezzullo JC, Olds G, et al. Risk of impaired renal function after colonoscopy: a cohort study in patients receiving either oral sodium phosphate or polyethylene glycol. Am J Gastroenterol. 2007;102:2655–63.PubMedGoogle Scholar
  56. 56.
    Hsu CW, Imperiale TF. Meta-analysis and cost comparison of polyethylene glycol lavage versus sodium phosphate for colonoscopy preparation. Gastrointest Endosc. 1998;48:276–82.PubMedGoogle Scholar
  57. 57.
    Cohen LB. Split dosing of bowel preparations for colonoscopy: an analysis of its efficacy, safety, and tolerability. Gastrointest Endosc. 2010;72:406–12.PubMedGoogle Scholar
  58. 58.
    Lichtenstein GR, Cohen LB, Uribarri J. Review article: Bowel preparation for colonoscopy–the importance of adequate hydration. Aliment Pharmacol Ther. 2007;26:633–41.PubMedGoogle Scholar
  59. 59.
    Karajeh MA, Sanders DS, Hurlstone DP. Colonoscopy in elderly people is a safe procedure with a high diagnostic yield: a prospective comparative study of 2000 patients. Endoscopy. 2006;38:226–30.PubMedGoogle Scholar
  60. 60.
    Ma WT, Mahadeva S, Kunanayagam S, Poi PJ, Goh KL. Colonoscopy in elderly Asians: a prospective evaluation in routine clinical practice. J Dig Dis. 2007;8:77–81.PubMedGoogle Scholar
  61. 61.
    Lukens FJ, Loeb DS, Machicao VI, Achem SR, Picco MF. Colonoscopy in octogenarians: a prospective outpatient study. Am J Gastroenterol. 2002;97:1722–5.PubMedGoogle Scholar
  62. 62.
    Burtin P, Bour B, Charlois T, Ruget O, Cales P, Dauver A, et al. Colonic investigations in the elderly: colonoscopy or barium enema? Aging (Milano). 1995;7:190–4.Google Scholar
  63. 63.
    Chatrenet P, Friocourt P, Ramain JP, Cherrier M, Maillard JB. Colonoscopy in the elderly: a study of 200 cases. Eur J Med. 1993;2:411–3.PubMedGoogle Scholar
  64. 64.
    George ML, Tutton MG, Jadhav VV, Abulafi AM, Swift RI. Colonoscopy in older patients: a safe and sound practice. Age Ageing. 2002;31:80–1.PubMedGoogle Scholar
  65. 65.
    Schmilovitz-Weiss H, Weiss A, Boaz M, Levin I, Chervinski A, Shemesh E. Predictors of failed colonoscopy in nonagenarians: a single-center experience. J Clin Gastroenterol. 2007;41:388–93.PubMedGoogle Scholar
  66. 66.
    Duncan JE, Sweeney WB, Trudel JL, Madoff RD, Mellgren AF. Colonoscopy in the elderly: low risk, low yield in asymptomatic patients. Dis Colon Rectum. 2006;49:646–51.PubMedGoogle Scholar
  67. 67.
    Syn WK, Tandon U, Ahmed MM. Colonoscopy in the very elderly is safe and worthwhile. Age Ageing. 2005;34:510–3.PubMedGoogle Scholar
  68. 68.
    Ristikankare M, Hartikainen J, Heikkinen M, Janatuinen E, Julkunen R. The effects of gender and age on the colonoscopic examination. J Clin Gastroenterol. 2001;32:69–75.PubMedGoogle Scholar
  69. 69.
    Ure T, Dehghan K, Vernava 3rd AM, Longo WE, Andrus CA, Daniel GL. Colonoscopy in the elderly. Low risk, high yield. Surg Endosc. 1995;9:505–8.PubMedGoogle Scholar
  70. 70.
    Nelson DB, McQuaid KR, Bond JH, Lieberman DA, Weiss DG, Johnston TK. Procedural success and complications of large-scale screening colonoscopy. Gastrointest Endosc. 2002;55:307–14.PubMedGoogle Scholar
  71. 71.
    Yancik R. Cancer burden in the aged: an epidemiologic and demographic overview. Cancer. 1997;80:1273–83.PubMedGoogle Scholar
  72. 72.
    Ko CW, Sonnenberg A. Comparing risks and benefits of colorectal cancer screening in elderly patients. Gastroenterology. 2005;129:1163–70.PubMedGoogle Scholar
  73. 73.
    Warren JL, Klabunde CN, Mariotto AB, Meekins A, Topor M, Brown ML, et al. Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med. 2009;150:849–57. W152.PubMedGoogle Scholar
  74. 74.
    Kahi CJ, Azzouz F, Juliar BE, Imperiale TF. Survival of elderly persons undergoing colonoscopy: implications for colorectal cancer screening and surveillance. Gastrointest Endosc. 2007;66:544–50.PubMedGoogle Scholar
  75. 75.
    van de Poll-Franse LV, Haak HR, Coebergh JW, Janssen-Heijnen ML, Lemmens VE. Disease-specific mortality among stage I-III colorectal cancer patients with diabetes: a large population-based analysis. Diabetologia. 2012;55:2163–72.PubMedCentralPubMedGoogle Scholar
  76. 76.
    Gross CP, McAvay GJ, Guo Z, Tinetti ME. The impact of chronic illnesses on the use and effectiveness of adjuvant chemotherapy for colon cancer. Cancer. 2007;109:2410–9.PubMedGoogle Scholar
  77. 77.
    Stavrou EP, Lu CY, Buckley N, Pearson S. The role of comorbidities on the uptake of systemic treatment and 3-year survival in older cancer patients. Ann Oncol. 2012;23:2422–8.PubMedGoogle Scholar
  78. 78.
    Sarfati D, Tan L, Blakely T, Pearce N. Comorbidity among patients with colon cancer in New Zealand. N Z Med J. 2011;124:76–88.PubMedGoogle Scholar
  79. 79.
    Inadomi JM, Sonnenberg A. The impact of colorectal cancer screening on life expectancy. Gastrointest Endosc. 2000;51:517–23.PubMedGoogle Scholar
  80. 80.
    Sonnenberg A, Delco F. Cost-effectiveness of a single colonoscopy in screening for colorectal cancer. Arch Intern Med. 2002;162:163–8.PubMedGoogle Scholar
  81. 81.
    Lin OS, Kozarek RA, Schembre DB, Ayub K, Gluck M, Drennan F, et al. Screening colonoscopy in very elderly patients: prevalence of neoplasia and estimated impact on life expectancy. JAMA. 2006;295:2357–65.PubMedGoogle Scholar
  82. 82.
    Kistler CE, Kirby KA, Lee D, Casadei MA, Walter LC. Long-term outcomes following positive fecal occult blood test results in older adults: benefits and burdens. Arch Intern Med. 2011;171:1344–51.PubMedCentralPubMedGoogle Scholar
  83. 83.
    Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, Wilschut J, van Ballegooijen M, Kuntz KM. Evaluating test strategies for colorectal cancer screening: a decision analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;149:659–69.PubMedCentralPubMedGoogle Scholar
  84. 84.
    Maheshwari S, Patel T, Patel P. Screening for colorectal cancer in elderly persons: who should we screen and when can we stop? J Aging Health. 2008;20:126–39.PubMedGoogle Scholar
  85. 85.
    Lewis CL, Esserman D, DeLeon C, Pignone MP, Pathman DE, Golin C. Physician decision making for colorectal cancer screening in the elderly. J Gen Intern Med. 2013;28:1202–7.PubMedGoogle Scholar
  86. 86.
    Walter LC, Lindquist K, Nugent S, Schult T, Lee SJ, Casadei MA, et al. Impact of age and comorbidity on colorectal cancer screening among older veterans. Ann Intern Med. 2009;150:465–73.PubMedCentralPubMedGoogle Scholar
  87. 87.
    Mittal S, Lin YL, Tan A, Kuo YF, El-Serag HB, Goodwin JS. Limited life expectancy among a subgroup of medicare beneficiaries receiving screening colonoscopies. Clin Gastroenterol Hepatol. 2014;12:443–450 e1.PubMedGoogle Scholar
  88. 88.
    Gisbert JP, Chaparro M. Systematic review with meta-analysis: inflammatory bowel disease in the elderly. Aliment Pharmacol Ther. 2014;39:459–77.PubMedGoogle Scholar
  89. 89.
    Cheddani H, Dauchet L, Charpentier C, et al. DOP094: Cancer in elderly-onset inflammatory bowel disease: A population-based study (abstract). European Crohn's and Colitis Organisation 2014.Google Scholar
  90. 90.
    Wang YR, Cangemi JR, Loftus Jr EV, Picco MF. Rate of early/missed colorectal cancers after colonoscopy in older patients with or without inflammatory bowel disease in the United States. Am J Gastroenterol. 2013;108:444–9.PubMedGoogle Scholar
  91. 91.
    Doat S, Thiebaut A, Samson S, Ricordeau P, Guillemot D, Mitry E. Elderly patients with colorectal cancer: Treatment modalities and survival in France. National data from the ThInDiT cohort study. Eur J Cancer 2014.Google Scholar
  92. 92.
    Egenvall M, Schubert Samuelsson K, Klarin I, Lokk J, Sjovall A, Martling A, Gunnarsson U. Management of colon cancer in the elderly: a population-based study. Colorectal Dis 2014.Google Scholar
  93. 93.
    Guillerme F, Clavier JB, Nehme-Schuster H, Leroy V, Heitz D, Schumacher C, et al. Age impacts the pattern of care for elderly patients with rectal cancer. Int J Colorectal Dis. 2014;29:157–63.PubMedGoogle Scholar
  94. 94.
    Kim GM, Ahn JB, Rha SY, Kim HS, Kang B, Kim MW, et al. Changing treatment patterns in elderly patients with resectable colon cancer. Asia Pac J Clin Oncol. 2013;9:265–72.PubMedGoogle Scholar
  95. 95.
    Ahmed S, Howel D, Debrah S. The influence of age on the outcome of treatment of elderly patients with colorectal cancer. J Geriatr Oncol 2014. This article critically examines the factors associated with post-operative mortality rates in elderly patients with colorectal cancer.Google Scholar
  96. 96.
    Fujii S, Ishibe A, Ota M, Yamagishi S, Watanabe K, Watanabe J, et al. Short-term results of a randomized study between laparoscopic and open surgery in elderly colorectal cancer patients. Surg Endosc 2013.Google Scholar
  97. 97.
    Hatakeyama T, Nakanishi M, Murayama Y, Komatsu S, Shiozaki A, Kuriu Y, et al. Laparoscopic resection for colorectal cancer improves short-term outcomes in very elderly colorectal cancer patients. Surg Laparosc Endosc Percutan Tech. 2013;23:532–5.PubMedGoogle Scholar
  98. 98.
    Nakamura T, Sato T, Miura H, Ikeda A, Tsutsui A, Naito M, et al. Feasibility and outcomes of surgical therapy in very elderly patients with colorectal cancer. Surg Laparosc Endosc Percutan Tech. 2014;24:85–8.PubMedGoogle Scholar
  99. 99.
    Feliu J, Sereno M, Castro JD, Belda C, Casado E, Gonzalez-Baron M. Chemotherapy for colorectal cancer in the elderly: Whom to treat and what to use. Cancer Treat Rev. 2009;35:246–54.PubMedGoogle Scholar
  100. 100.
    Yee KW, Pater JL, Pho L, Zee B, Siu LL. Enrollment of older patients in cancer treatment trials in Canada: why is age a barrier? J Clin Oncol. 2003;21:1618–23.PubMedGoogle Scholar
  101. 101.
    Lewis JH, Kilgore ML, Goldman DP, Trimble EL, Kaplan R, Montello MJ, et al. Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol. 2003;21:1383–9.PubMedGoogle Scholar
  102. 102.
    Leo S, Accettura C, Gnoni A, Licchetta A, Giampaglia M, Mauro A, et al. Systemic treatment of gastrointestinal cancer in elderly patients. J Gastrointest Cancer. 2013;44:22–32. Thorough review that discusses current treatment recommendations for elderly patients with colorectal cancer.PubMedGoogle Scholar
  103. 103.
    Shayne M, Culakova E, Wolff D, Poniewierski MS, Dale DC, Crawford J, et al. Dose intensity and hematologic toxicity in older breast cancer patients receiving systemic chemotherapy. Cancer. 2009;115:5319–28.PubMedGoogle Scholar
  104. 104.
    Dotan E, Browner I, Hurria A, Denlinger C. Challenges in the management of older patients with colon cancer. J Natl Compr Canc Netw. 2012;10:213–24. quiz 225.PubMedCentralPubMedGoogle Scholar
  105. 105.
    Sundararajan V, Mitra N, Jacobson JS, Grann VR, Heitjan DF, Neugut AI. Survival associated with 5-fluorouracil-based adjuvant chemotherapy among elderly patients with node-positive colon cancer. Ann Intern Med. 2002;136:349–57.PubMedGoogle Scholar
  106. 106.
    Jehn CF, Boning L, Kroning H, Pezzutto A, Luftner D. Influence of comorbidity, age and performance status on treatment efficacy and safety of cetuximab plus irinotecan in irinotecan-refractory elderly patients with metastatic colorectal cancer. Eur J Cancer 2014.Google Scholar
  107. 107.
    Balducci L. Geriatric oncology. Crit Rev Oncol Hematol. 2003;46:211–20.PubMedGoogle Scholar
  108. 108.
    Wildes TM, Ruwe AP, Fournier C, Gao F, Carson KR, Piccirillo JF, et al. Geriatric assessment is associated with completion of chemotherapy, toxicity, and survival in older adults with cancer. J Geriatr Oncol. 2013;4:227–34.PubMedCentralPubMedGoogle Scholar
  109. 109.
    Berretta M, Di Benedetto F, Di Francia R, Lo Menzo E, Palmeri S, De Paoli P, et al. Colorectal cancer in elderly patients: from best supportive care to cure. Anticancer Agents Med Chem. 2013;13:1332–43.PubMedGoogle Scholar
  110. 110.
    Golan T, Urban D, Berger R, Lawrence YR. Changing prognosis of metastatic colorectal adenocarcinoma: Differential improvement by age and tumor location. Cancer. 2013;119:3084–91.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2014

Authors and Affiliations

  1. 1.Division of Gastroenterology, Department of MedicineSan Francisco General Hospital and Trauma CenterSan FranciscoUSA
  2. 2.Division of Gastroenterology, Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA

Personalised recommendations