Colorectal Cancer in the Elderly: How Do We Tailor Treatment with Chemotherapy and Radiotherapy Most Appropriately?

Colorectal cancer is the commonest malignancy in patients aged 75 years or older. The incidence is likely to rise further over the next two decades as the population ages and survival increases. Robust data on the adherence to guidelines for the elderly and the uptake of treatment in the elderly are limited—particularly with regard to rectal cancer. However, the evidence available suggests that clinical attitudes observed regarding age and cancer treatment are consistent. Older people with colorectal cancer tend to be offered either less intensive treatment or no treatment at all. Population data confirm that treatment rates for surgery, chemotherapy and radiotherapy in patients with colorectal cancer all decline for those over 70 years old, and continue to decline exponentially with increasing age. So should new, more tolerable strategies which may avoid radical surgery be more widely available (short-course preoperative radiotherapy, chemoradiotherapy, transanal excision microsurgery, brachytherapy, contact therapy)? It is not clear if oncologists are always making the most appropriate management decisions. So how do oncologists and surgeons balance chronological age, comorbidity, social isolation and other influences in their clinical decision-making? We need to recognise that this is a difficult issue and will be an increasing issue for multidisciplinary teams.