Clinical Research Papers:
Patterns of care and treatment outcomes in older patients with biliary tract cancer
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Anne Horgan1,2, Jennifer Knox1, Priya Aneja1, Lisa Le3, Elizabeth McKeever1, Mairead McNamara1,4
1Princess Margaret Cancer Centre, Department of Medical Oncology, Toronto, ON, Canada
2Present address: University Hospital Waterford, Department of Medical Oncology, Ardkeen, Waterford, Ireland
3Princess Margaret Cancer Centre, Department of Biostatistics, Toronto, ON, Canada
4Present address: The Christie NHS Foundation Trust/University of Manchester, Institute of Cancer Sciences, Manchester, UK
Anne Horgan, e-mail: [email protected]
Keywords: biliary tract cancer, elderly, treatment
Received: June 07, 2015 Accepted: October 27, 2015 Published: November 09, 2015
Background: Although biliary tract cancers (BTC) are common in older age-groups, treatment approaches and outcomes are understudied in this population.
Patients and Methods: Data from 913 patients diagnosed with BTC from January 1987 to July 2013 and treated at Princess Margaret Cancer Center, Toronto were analyzed. The differences in treatment patterns between older and younger patients were explored and the impact of age, patient and disease characteristics on survival outcomes was assessed.
Results: Three hundred and twenty one patients ≥70 years were identified. Older patients were more likely to receive best supportive care, 40% (n = 130), compared to younger patients 26% (n = 154); p < 0.0001. On multivariable analysis, factors associated with receipt of surgery included stage I/II disease (p < 0.0001) and ECOG PS < 2 (p < 0.0001). Older age was not associated with lack of surgical intervention. In comparison, older age was associated with non-receipt of palliative chemotherapy (p = 0.0007). Similar survival benefit from treatment was seen in older and younger patients. Of 626 patients that underwent either surgery or palliative chemotherapy (n = 188), the median survival was 21.1 months (95% CI 19.0–27.9) in patients >70 years of age, and 21.1 months in younger patients (n = 438) (95% CI 19.5–24.5).
Conclusion: In this large retrospective analysis, older patients with BTC are less likely to undergo an intervention. However, active therapy when given is associated with similar survival benefits, irrespective of age.
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