Skip to main content

Advertisement

SpringerLink
Log in

Guideline Recommended Gastric Cancer Care in the Elderly: Insights into the Applicability of Cancer Trials to Real World

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

Abstract

Background

Given the underrepresentation of older persons in cancer trials, the association between increasing age and receipt of recommended gastric cancer care in the United States was examined.

Materials and Methods

Using the 1998–2006 SEER database, 8637 Medicare-eligible patients, aged ≥65 years who underwent gastrectomy for nonmetastatic gastric adenocarcinoma were identified. Multivariate analyses was used to assess the effect of increasing age on receipt of recommended gastric cancer care (adequate lymph node evaluation [≥15 lymph nodes] and adjuvant radiation therapy for AJCC Ib–IVM0) and cancer-specific mortality controlling for covariates.

Results

While 61% of gastric cancer operations were performed in patients ≥65 years, less than 30% received adequate lymphadenectomy or adjuvant radiation therapy. Older patients were less likely to receive adequate nodal evaluation and adjuvant radiotherapy (P < 0.0001). These findings persisted on multivariate analyses. Older age was also associated with worse cancer-specific mortality. Because an age-tumor location interaction for cancer mortality (P = 0.047) was observed, stratified analyses were performed which showed that the adverse effect of older age on cancer-specific mortality was augmented in proximal gastric cancers.

Conclusions

This population-based study showed significant age-based variations in gastric cancer care. These results should encourage assessment of generalizability of gastric cancer trials to this expanding population of elderly in the era of comparative effectiveness research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol. 2006;12:354–62.

    PubMed  Google Scholar 

  2. Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345:725–30.

    Article  CAS  PubMed  Google Scholar 

  3. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71–96.

    Article  PubMed  Google Scholar 

  4. Jemal A, Ward E, Hao Y, Thun M. Trends in the leading causes of death in the United States, 1970–2002. JAMA. 2005;294:1255–9.

    Article  CAS  PubMed  Google Scholar 

  5. Yabroff KR, Lamont EB, Mariotto A, Warren JL, Topor M, Meekins A, et al. Cost of care for elderly cancer patients in the United States. J Natl Cancer Inst. 2008;100:630–41.

    Article  PubMed  Google Scholar 

  6. Murthy VH, Krumholz HM, Gross CP. Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA. 2004;291:2720–6.

    Article  CAS  PubMed  Google Scholar 

  7. Al-Refaie WB, Haberman EB, Dudeja V, Vickers SM, Tuttle TM, Jensen EH, et al. Extremity soft tissue sarcoma care in the elderly: insights into the generalizability of NCI Cancer Trials. Ann Surg Oncol. 2010;17:1732–8.

    Article  PubMed  Google Scholar 

  8. Adam DJ, Craig SR, Sang CT, Cameron EW, Walker WS. Esophagectomy for carcinoma in the octogenarian. Ann Thorac Surg. 1996;61:190–4.

    Article  CAS  PubMed  Google Scholar 

  9. Gornick ME, Warren JL, Eggers PW, Lubitz JD, De Lew N, Davis MH, et al. Thirty years of Medicare: impact on the covered population. Health Care Financ Rev. 1996;18:179–237.

    CAS  PubMed  Google Scholar 

  10. Greene FL Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M, eds. American Joint Committee on Cancer: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002.

    Google Scholar 

  11. Baxter NN, Tuttle TM. Inadequacy of lymph node staging in gastric cancer patients: a population-based study. Ann Surg Oncol. 2005;12:981–7.

    Article  PubMed  Google Scholar 

  12. Coburn NG, Guller U, Baxter NN, Kiss A, Ringash J, Swallow CJ, et al. Adjuvant therapy for resected gastric cancer—rapid, yet incomplete adoption following results of intergroup 0116 trial. Int J Radiat Oncol Biol Phys. 2008;70:1073–80.

    Article  PubMed  Google Scholar 

  13. Al-Refaie WB, Gay G, Virnig BA, Tseng JF, Stewart A, Vickers SM, et al. Variations in gastric cancer care: a trend beyond racial disparities. Cancer. 2010;116:465–75.

    Article  PubMed  Google Scholar 

  14. Strauss J, Hershman DL, Buono D, McBride R, Clark-Garvey S, Woodhouse SA, et al. Use of adjuvant 5-fluorouracil and radiation therapy after gastric cancer resection among the elderly and impact on survival. Int J Radiat Oncol Biol Phys. 76:1404–12.

  15. Al-Refaie WB, Parsons HM, Henderson WG, Jensen EH, Tuttle TM, Vickers SM, et al. Major cancer surgery in the elderly: results from the American College of Surgeons National Surgical Quality Improvement Program. Ann Surg. 2010;26:311–8.

    Article  Google Scholar 

  16. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20.

    Article  CAS  PubMed  Google Scholar 

  17. Shavers VL, Harlan LC, Jackson M, Robinson J. Racial/ethnic patterns of care for pancreatic cancer. J Palliat Med. 2009;12:623–30.

    Article  PubMed  Google Scholar 

  18. Shavers VL, Harlan LC, Stevens JL. Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35. Cancer. 2003;97:134–47.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

Supported by The 2008 Veterans of Foreign Wars (VFW) and Ladies Cancer Research Center Endowment Fund.

Author information

Authors and Affiliations

  1. Department of Surgery, The University of Minnesota, Minneapolis, MN, USA

    Vikas Dudeja MD, Elizabeth B. Habermann MPH, PhD, Wei Zhong MS, Todd M. Tuttle MD, FACS, MS, Selwyn M. Vickers MD, FACS & Eric H. Jensen MD

  2. Division of surgical oncology, Department of Surgery, Mayo Mail Code 195, The University of Minnesota and Minneapolis Veteran Affairs Medical Center, Minneapolis, MN, USA

    Waddah B. Al-Refaie MD, FACS

Authors
  1. Vikas Dudeja MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth B. Habermann MPH, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei Zhong MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Todd M. Tuttle MD, FACS, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Selwyn M. Vickers MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eric H. Jensen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Waddah B. Al-Refaie MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Waddah B. Al-Refaie MD, FACS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dudeja, V., Habermann, E.B., Zhong, W. et al. Guideline Recommended Gastric Cancer Care in the Elderly: Insights into the Applicability of Cancer Trials to Real World. Ann Surg Oncol 18, 26–33 (2011). https://doi.org/10.1245/s10434-010-1215-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-010-1215-9

Keywords

Search

Navigation