Abstract 4116
Background
Older cancer patients often have fewer staging interventions and inferior treatment than younger patients. Suboptimal cancer management in older patients is frequently attributed to comorbidity, which may contraindicate procedures. We aim to examine how much of the age disparities in completeness of staging investigations for colorectal cancer (CRC) are explained by patients’ health status and their diagnostic route.
Methods
Population-based cancer registries provided information on CRC patients diagnosed in England during 2010-2012. Staging investigations and comorbidities in the six years before the cancer diagnosis was derived from the National Bowel Cancer Audit and Hospital Episodes Statistics datasets. A mediation analysis quantified the proportion of the age effect on staging investigations mediated by health status, and by the diagnosis route. Sensitivity analyses for unmeasured confounding tested the robustness of the findings.
Results
Around half of patients had complete staging investigations. There was a U-shape association with more complete investigations among those aged 60-69. The age-investigation association was barely mediated by health status, but was partly mediated by being diagnosed through an emergency route. Overall, an important proportion of the age differential was not mediated by these factors, especially in older patients. These findings were robust to strong assumptions of unmeasured confounding of the relationship between the diagnosis route and having complete staging investigations.
Conclusions
CRC patients’ health status and diagnostic route did not fully explain the age differential in the quality of staging investigations, contradicting prevailing beliefs. Findings suggest factors other than patients’ health status may play an important role in the age differential. Although some patients may not benefit from aggressive treatment, having a complete investigation is essential to plan optimal management, regardless of age.
Clinical trial identification
Legal entity responsible for the study
London School of Hygiene and Tropical Medicine.
Funding
Cancer Research UK.
Editorial Acknowledgement
Disclosure
All authors have declared no conflicts of interest.
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