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Age-specific differences in the diagnostics and treatment of cancer patients aged 50 years and older in the province of Limburg, The Netherlands.

BACKGROUND
In the Netherlands, 45% of all cancer cases occur in men and women aged 70 years and older. Since the population is ageing and cancer incidence rises with age, the number of new malignancies in the elderly is increasing. It has become apparent that there is a relationship between age at diagnosis and the treatment received. Therefore, age-specific variations in patterns of care for six common forms of cancer in the elderly, are examined.


PATIENTS AND METHODS
Patients aged 50 years and older, diagnosed in the period 1988-1992 in Middle and South Limburg with breast, colorectal, lung, ovarian, head and neck cancer and non-Hodgkin lymphoma were included (n = 6911). Data were obtained from the population-based Regional Cancer Registry of the Comprehensive Cancer Centre Limburg. Age-specific differences in diagnostics and treatment were analysed using chi-square analysis (age categories: 50-59, 60-69, 70+). Logistic regression analyses were used to examine the extent to which age increased the chance of not being treated or of receiving less intensive treatment, while controlling for the stage of the disease and the sex of the patient.


RESULTS
For all malignancies the stage was unknown in a larger proportion of the patients aged 70 years and older than in the younger patient groups. Compared to their younger counterparts, the diagnosis of elderly breast, colorectal and lung cancer patients was more often based solely on clinical grounds. In the total study population, 16% were not treated. Per age category 50-59 years, 60-69 years and 70+ these percentages were 7%, 12% and 22%, respectively, (P-trend = 0.001). For all malignancies the chance of not receiving treatment increased with increasing age. However, the size and nature of the differences varied with the localisation of the tumour. The proportion of untreated patients was particularly high in the patients with lung cancer and metastatic colorectal and ovarian cancer, and there was an increase with increasing age (P-trend = 0.001). The vast majority of patients with NHL, breast, head and neck and non-metastatic colorectal cancer received treatment, 90%, 94%, 91%, and 99%, respectively. However, elderly patients less often received a combination of treatment modalities.


CONCLUSIONS
The diagnostics and choice of treatment for several common types of cancer were dependent on age. This study could not take into account the major problem of co-morbidity which can be a reason to choose for lesser therapy in the elderly. More research is necessary to determine which factors determine the diagnostics and choice of treatment and whether these factors differ between young and elderly patients.