173 411

Cited 3 times in

Increasing disparities in the proportions of active treatment and 5-year overall survival over time by age groups among older patients with gastric cancer in Korea

Authors
 Hyun-Soo Zhang  ;  Dong-Woo Choi  ;  Han Sang Kim  ;  Hye Jung Kang  ;  Hoyol Jhang  ;  Wonjeong Jeong  ;  Chung Mo Nam  ;  Sohee Park 
Citation
 FRONTIERS IN PUBLIC HEALTH, Vol.10 : 1030565, 2023-01 
Journal Title
FRONTIERS IN PUBLIC HEALTH
Issue Date
2023-01
MeSH
Aged ; Aged, 80 and over ; Comorbidity ; Female ; Frailty* ; Humans ; Male ; Republic of Korea / epidemiology ; Risk Factors ; Stomach Neoplasms* / diagnosis ; Stomach Neoplasms* / epidemiology ; Stomach Neoplasms* / therapy
Keywords
aged 85 and over ; geriatric assessment (MeSH) ; stomach neoplasms ; survival ; therapeutics
Abstract
Purpose: As older patients with gastric cancer increase in Korea, no consensus indicative of anti-cancer treatment exists for the oldest old (age 85+). We investigated potential disparities in the proportion of surgery-including active treatment and the degree of survival improvement over time by age groups, and whether heterogeneity exists in the protective effect of time period on overall survival (OS) by age at diagnosis clusters.

Materials and methods: A nationwide cohort (N = 63,975) of older patients with gastric cancer (age at diagnosis 70+) in 2005-2012 were followed until the end of 2018. Patients were categorized into four time period groups by their year of diagnosis. Cancer treatment patterns and 5-year OS were analyzed accordingly, and a random coefficients Cox model with random intercepts and random slopes of time period by age at diagnosis clusters was employed.

Results: The mean age of patients was 76.4, and 60.4% were males. Most patients had 0-1 comorbidities (73.3%) and low-risk frailty scores (74.2%). Roughly two-thirds of patients received some form of anti-cancer treatment (62.4%), and while the number of comorbidities and the proportion of high-risk frailty scores trended toward an increase, the proportion of patients receiving anti-cancer treatment increased from 58% in 2005-2006 to 69.6% in 2011-2012. The proportion of surgery-including active treatment increased to over 70% in the 70-74 years old group, while stagnating at 10% in the 90+ years old group. Differences in the slope of 5-year OS improvement resulted in a widening survival gap between the old (age 70-84) and the oldest old. The protective effect of time period on OS hazard in the oldest old was not monotonically reduced with increasing "chronological" age but varied quite randomly, especially among female patients.

Conclusion: Our study showed no upper age limit in terms of benefiting from the advances in the detection and treatment of gastric cancer over time. Thus, "functional" age rather than "chronological" age should be the criterion for anti-cancer screening and treatment, and actual implementation of proven treatments in the oldest old patients to reduce their non-compliance with treatment in clinical practice is needed to improve gastric cancer survival for all.
Files in This Item:
T202301629.pdf Download
DOI
10.3389/fpubh.2022.1030565
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
Yonsei Authors
Kim, Han Sang(김한상) ORCID logo https://orcid.org/0000-0002-6504-9927
Nam, Chung Mo(남정모) ORCID logo https://orcid.org/0000-0003-0985-0928
Park, So Hee(박소희) ORCID logo https://orcid.org/0000-0001-8513-5163
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/193720
사서에게 알리기
  feedback

qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Browse

Links