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Predictors of Short-Term Postoperative Survival After Elective Colectomy in Colon Cancer Patients ≥80 Years of Age

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Individuals ≥80 years of age represent an increasing proportion of colon cancer diagnoses. Selecting these patients for elective surgery is challenging because of diminished overall health, functional decline, and limited data to guide decisions. The objective was to identify overall health measures that are predictive of poor survival after elective surgery in these oldest-old colon cancer patients.

Methods

Medicare beneficiaries ≥80 years who underwent elective colectomy for stage I–III colon cancer from 1992–2005 were identified from the Surveillance, Epidemiology and End Results(SEER)-Medicare database. Kaplan–Meier survival analysis determined 90-day and 1-year overall survival. Multivariable logistic regression assessed factors associated with short-term postoperative survival.

Results

Overall survival for the 12,979 oldest-old patients undergoing elective colectomy for colon cancer was 93.4 and 85.7 %, at 90 days and 1 year. Older age, male gender, frailty, increased hospitalizations in prior year, and dementia were most strongly associated with decreased survival. In addition, AJCC stage III (vs stage I) disease and widowed (vs married) were highly associated with decreased survival at 1 year. Although only 4.4 % of patients were considered frail, this had the strongest association with mortality, with an odds ratio of 8.4 (95 % confidence interval, 6.4–11.1).

Conclusions

Although most oldest-old colon cancer patients do well after elective colectomy, a significant proportion (6.6 %) die by postoperative day 90 and frailty is the strongest predictor. The ability to identify frailty through billing claims is intriguing and suggests the potential to prospectively identify, through the electronic medical record, patients at highest risk of decreased survival.

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Acknowledgment

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. The collection of the California cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement No. U55/CCR921930-02 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. Support for this project was provided by the Health Innovation Program and the Community-Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research (UW ICTR), grant 1UL1RR025011 from the Clinical and Translational Science Award program of the National Center for Research Resources, National Institutes of Health and by the University of Wisconsin Carbone Cancer Center, grant P30CA014520-34 from the National Cancer Institute, National Institutes of Health. Additional funding for this project was provided by the UW School of Medicine and Public Health from The Wisconsin Partnership Program.

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Authors and Affiliations

  1. Department of Surgery, UW Madison School of Medicine and Public Health, Madison, Wisconsin, USA

    Heather B. Neuman MD, Glen Leverson PhD, Erin S. O’Connor MD, MS, David Y. Greenblatt MD, MS, Caprice C. Greenberg MD, MPH & Maureen A. Smith MD, PhD, MPH

  2. Department of Medicine, Division of Gastroenterology and Hepatology, UW Madison School of Medicine and Public Health, Madison, Wisconsin, USA

    Jennifer M. Weiss MD, MS

  3. Department of Medicine, Division of Hematology and Oncology, UW Madison School of Medicine and Public Health, Madison, Wisconsin, USA

    Noelle K. LoConte MD

  4. Department of Population Health Sciences, UW Madison School of Medicine and Public Health, Madison, Wisconsin, USA

    Maureen A. Smith MD, PhD, MPH

  5. Department of Family Medicine, UW Madison School of Medicine and Public Health, Madison, Wisconsin, USA

    Maureen A. Smith MD, PhD, MPH

Authors
  1. Heather B. Neuman MD
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  2. Jennifer M. Weiss MD, MS
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  3. Glen Leverson PhD
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  4. Erin S. O’Connor MD, MS
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  5. David Y. Greenblatt MD, MS
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  6. Noelle K. LoConte MD
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  7. Caprice C. Greenberg MD, MPH
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  8. Maureen A. Smith MD, PhD, MPH
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Corresponding author

Correspondence to Heather B. Neuman MD.

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Neuman, H.B., Weiss, J.M., Leverson, G. et al. Predictors of Short-Term Postoperative Survival After Elective Colectomy in Colon Cancer Patients ≥80 Years of Age. Ann Surg Oncol 20, 1427–1435 (2013). https://doi.org/10.1245/s10434-012-2721-8

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  • DOI: https://doi.org/10.1245/s10434-012-2721-8

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