Elderly Patients with Esophageal Cancers Might Tolerate Multimodal Therapy Well

By Jonathan Springston, Editor, Relias Media

Older patients with esophageal cancers may not be receiving the most complete therapy because of perceptions about age-related risk. But those who do undergo a thorough treatment course may experience similar outcomes as younger patients, according to the results of a recent investigation.

From Jan. 1, 2004, to Dec. 31, 2019, patients with esophageal or esophagogastric junction cancer underwent primary treatment at a single institution. Patients older than age 70 years were considered the “older” group (n = 94; mean age, 74 years) and those younger than age 70 years were the “younger” group (n = 188; mean age, 59 years).

All these patients underwent neoadjuvant chemoradiotherapy and surgical resection for stage II and higher cancer. This treatment regimen is considered the care standard for patients with this cancer type who are in stages II or III. However, other research indicates older patients may be less likely to undergo this multistep treatment course because of concerns about age and frailty.

However, these researchers observed similar postoperative complication severity scores, perioperative mortality rates, and lengths of stay between younger and older patients. The long-term, age-adjusted survival rate was 44.8% at five years for the older group and 39% for the younger group.

“Patients 70 years and older with locally advanced esophageal or esophagogastric junction cancer should be evaluated for optimal curative therapy, including neoadjuvant chemoradiotherapy and surgical resection,” the authors concluded. “Although preoperative risk-scoring and postoperative atrial arrhythmias are higher in the older group, short- and long-term outcomes are not inferior in these patients.”

This study was conducted at one institution and it was not randomized. Additionally, the authors underlined the importance of excluding older patients with these cancers from surgery if they suffer from chronic or unstable conditions of the heart, lungs, or liver. Further, they recommended potentially eligible patients should undergo cardiac stress tests and be able to achieve certain physical fitness benchmarks.

The upcoming March issue of Medical Ethics Advisor includes an article about a recent study that revealed frail older adults undergoing emergency general surgery receive more aggressive end-of-life care than older adults who are not frail.

Researchers analyzed data of more than 138,000 adults older than age 66 years who underwent partial colectomy, small bowel resection, laparotomy, adhesiolysis, or peptic ulcer disease repair between 2008 and 2014 who died within one year. Of that group, patients with any degree of frailty went to hospice less often, spent fewer days at home, and needed higher-intensity care at the end of life. These findings suggest the most vulnerable patients might be subjected to the most burdensome treatment.

For more information on outpatient procedures, be sure to read the latest issues of Same-Day Surgery.