Age-related guideline adherence and outcome in XXXX .

@entity1 @entity5
BACKGROUND: Care for elderly @entity1 with @entity5 can pose dilemmas, because radical total mesorectal excision surgery comes with high morbidity and mortality rates. OBJECTIVE: The purpose of this study was to analyze the treatment of @entity1 with @entity5 , comparing treatment choices, guideline adherence, and outcomes for elderly @entity1 (>= 75 years) with younger @entity1 (<75 years). DESIGN: @entity1 data were retrieved from the hospital pathology database and from the hospital prospective colorectal surgery database for surgically treated @entity1 . Records were reviewed for nonadherence to treatment guidelines. Delivered treatment modalities for @entity1 with stage I to @entity5 were compared with treatment advised by national guidelines, and reasons stated by the treating physician for nonadherence to guidelines were subsequently collected. SETTINGS: This study was performed at a high-volume teaching hospital. @entity1 : @entity1 included were those with newly diagnosed @entity5 ( <=10 cm from the anal verge). MAIN OUTCOME MEASURES: Treatment decisions, guideline adherence, and outcome of surgical treatment were the main outcome parameters. RESULTS: Of 218 included @entity1 , 75 (34%) were aged >= 75 years. Guideline adherence for all of the treatment modalities in stage I to @entity5 was significantly lower in elderly @entity1 (62% versus 87% for aged <75 years; p < 0.001), and age was the primary reason mentioned for withholding treatment. Palliative anticancer treatment for stage IV disease was also initiated significantly less frequently in elderly @entity1 (60% versus 97%; p = 0.002). Overall rates of treatment complications were similar for both @entity1 groups (p = 0.71), but the impact of complications on survival was much greater for elderly @entity1 (p = 0.002). LIMITATIONS: Data on outcome of other treatment modalities, such as chemotherapy and radiotherapy, are lacking. CONCLUSIONS: Guideline adherence for all of the treatment modalities in stage I to @entity5 declines significantly with increasing age. Future research should focus on strategies of treatment tailored to @entity1 health status rather than chronological age.
