Is There Ageism in Oncology?

Abstract

Objective: To use routine data to explore age-related decision making in the hospital management of colorectal cancer. Design: Retrospective analysis of linked Scottish cancer registry and hospital discharge data for colorectal cancer. Setting: All Scottish general hospitals. Participants: All patients on the Scottish colorectal cancer registry 1992–6 (n=15.299). Main Results: Histological verification was used to indicate the “gold standard” of investigation. Definitive surgery and chemotherapy were used as indicators of treatment received. After adjusting for demographic factors, tumour sub-site, co-morbidity and route of first admission, increasing age was associated with markedly decreased rates of histological verification, surgery and chemotherapy. It is still not possible to be sure whether there is ageism in the management of older patients with colorectal cancer. However, the rate of histological verification fell markedly with increasing age, making it questionable whether decisions to treat were based on best clinical practice at the time. Differences observed between this study and clinical trial data may represent the margin of ageism between everyday clinical practice and controlled conditions. Conclusions: The value of this analysis lies in the fact that the data come from routine clinical practice rather than special studies. The improved content of Scottish cancer register and the ability to link it to hospital care provides a useful baseline for monitoring adherence to clinical guidelines.