Clinical Colorectal Cancer Submission: A Retrospective Study Colorectal Cancer Screening in the Elderly: Is Age Just a Number?

Abstract Introduction: Colorectal cancer screening improved outcomes for patients diagnosed between the age of 45-75. Present life expectancy is beyond this limit, yet there are no guidelines for these ages. We aim to identify outcomes after screening and intervention in patients ≥75 years and correlate with frailty. Materials and Methods: Records between 2011-2019 were queried. Patients ≥75 screened and treated for colorectal cancer were included. Patient demographics, perioperative mortality, age at last colonoscopy and frailty score were calculated. A Modified Frailty Index from the Canadian Study of Health and Aging Frailty Index was used. A score of 1 to 11 was calculated based on patient comorbidities. The MFI was assigned from 0 to 11: 0 signified absence of frailty and 11 indicated maximum frailty. Results: 179 patients were identified, 46.3% males. 171(95%) had elective and 8 (5%) had emergent surgery. The average age was 81.8 years. All colonoscopies were performed for symptoms. A modified frailty index was retrospectively calculated; 75% of patients scored between 0 and 2 and 1% scored >6. Conclusion: Older patients who underwent colonoscopy and surgery for symptomatic colon cancer had a low mortality, 2%. The average age was 6.8 years older than the recommended cutoff for colonoscopy screening. Most patients scored 0-2 on the modified frailty index, suggesting that not only are older patients more fit than previously thought, but also able to tolerate colorectal interventions more liberally. Utilizing frailty indices to identify screening patterns beyond 75 years of age might prove beneficial for this patient population. Further studies are recommended. Clinical Practice Points: We know as a medical society that colorectal cancer screening has improved outcomes for patients diagnosed between 45-75 years. However, the average American life expectancy is 82 years and currently there are no guidelines for screening patients ≥75. In our study, we examined 179 patients at our community hospital who had undergone colonoscopy, had a positive screening, and then underwent surgery. The average age of these individuals was 82 years. We went a step further to score these patients using an objective frailty scale. The average score was 0-2 and the average surgical mortality of these patients was ≤ 2%. This showed that although the patients we studied were elderly, the majority were not frail. In the future, clinical practices may start utilizing frailty indices to identify screening patterns in patients ≥75 who could benefit from a colonoscopy and potential surgical cancer resection. In turn, this would lead to more elderly patients undergoing colon cancer screening as well as possible resection of their cancer and potential cure. Ultimately, the main clinical goal with further research would be to establish screening guidelines for patients greater than 75 years of age. Micro abstract: Colorectal cancer screening has improved outcomes for patients diagnosed between 45-75 years. The average American life expectancy is 82. There are no guidelines for screening patients ≥75 years. We examined 179 patients (average age 82) who underwent surgery after a positive colonoscopy and the surgical mortality was ≤ 2%. We found that utilizing frailty indices to identify screening patterns in patients ≥75 could prove beneficial for predicting outcomes after colonoscopy and surgery.