Surgical under-treatment in older cancer patients

• Research type

  Research Study

• Full title

  Quantifying Surgical Under-treatment in Older Adult Breast, Lung and Colorectal Cancer Patients

• IRAS ID

  247275

• Contact name

  Finian Bannon

• Contact email

  f.j.bannon@qub.ac.uk

• Sponsor organisation

  Queen's University Belfast

• Duration of Study in the UK

  1 years, 0 months, 1 days

• Research summary

  Cancer is amongst the leading causes of morbidity and mortality worldwide and is the most common cause of death (29%) in Northern Ireland [1]. The number of people over 65 is projected to increase by 40% in NI, between 2010 and 2025. Older adults are less likely to receive optimal curative cancer therapies and have poorer survival outcomes [2,3].
  Investigation into sub-optimal treatment in elderly cancer patients has not adjusted for the combined-effects of key variables such as stage, comorbidity and frailty. In particular, self-reported morbidities and frailty markers derived from the Census data have not been used. In addition, few studies have assessed under-treatment’s effect on survival, and none have adopted a causal-inference methodological approach.

  To discover how much of the difference in survival between young and old is mediated through lower surgery in the elderly, having adjusted for clinical and demographic factors?

  From the Northern Ireland Cancer Registry (NICR), a population-based cancer registry, 8,131 breast, 7,442 lung, and 7,233 colorectal cancer patients will be linked to the 2011 Census data supplied by the Census Office through the Administrative Data Research Centre Northern Ireland (ADRC-NI). The NICR will bring patients’ tumour (e.g. stage), treatment modality, and comorbidity information. The ADRC will enable linkage to health information on frailty (e.g. Q22 & Q24, 2011 NI Census) and comorbidity (Q23, 2011 NI Census), ethnicity, and socio-economic factors.
  The combining of key variables from both NICR and the Northern Ireland 2011 census via ADRC will provide an unprecedented opportunity to adjust for relevant sources of confounding at an individual level. Using g-computation formula, ‘under-treatment’ will be identified by estimating the Natural Indirect Effect of age on survival mediated through surgery, accounting for the natural direct effect of age, through of disease and frailty in the elderly, on surgery and survival.

  References:
  1. NISRA - Registrar General Annual Report 2014: Cause of Death. Available at: http://www.nisra.gov.uk/archive/demography/publications/annual_reports/2014/CauseOfDeath.pdf. Accessed 13/03/2017
  2. Bouchardy C, Rapiti E, Blagojevic S, Vlastos AT and Vlastos G. Older Female Cancer Patients: Importance, Causes, and Consequences of Undertreatment. J Clin Oncol (2007) 25:1858-1869.
  3. Søgaard M, Thomsen RW, Bossen KS, Sørensen HT, Nørgaard N. The impact of comorbidity on cancer survival: a review. Clinical Epidemiology 2013:5 (Suppl 1) 3–29

• REC name

  London - City & East Research Ethics Committee

• REC reference

  18/LO/0829

• Date of REC Opinion

  30 May 2018

• REC opinion

  Favourable Opinion