Quality Indicators for the Care of Colorectal Cancer in Vulnerable Elders

Colorectal cancer is the third most common cancer diagnosed in the United States in both sexes and has the third highest cancer-related mortality. Colorectal cancer is primarily a disease of elderly people, because the median age of colorectal cancer patients at the time of diagnosis is 72. Age also influences colorectal cancer outcomes. Based on a systematic review of the literature on colorectal cancer surgery, 30-day postoperative mortality was significantly higher in elderly patients than in those younger than 65, and 1.8, 3.2, and 5.2 times as high in those aged 65 to 74, 75 to 84, and 85 and older, respectively. However, some elderly patients (even those aged =85) have survived longer than 2 years, suggesting that elderly patients should not be denied operative intervention based on age alone. METHOD: Previous research has also found significant variability within the elderly population in rates of colorectal cancer screening, surgery, and use of adjuvant chemotherapy or radiation therapy. The current review presents the quality indicators (QIs) for vulnerable elders (VEs) with colorectal cancer that the expert panel rated as valid, along with the available data in support of each of these indicators. RESULTS: A total of 138 articles were considered in this review: 18 identified via a Web search, 108 identified through reference mining, and 12 that were included after peer review. Of the 22 potential QIs, the expert panel process judged 21 to be valid; one indicator was rejected. The literature summaries that support each of the indicators judged to be valid in the expert panel process are described. Where applicable and available, the ages of the study participants were included to provide the reader with an estimate of the proportion of elderly patients in each study.