Bridging the Evidence Gap: A Retrospective Lens on Survival and Treatment Patterns in Older Patients With Colorectal...

To advise evidence-based strategies and healthcare policies to optimize the management of older adults with colorectal cancer (CRC) in the region. Older adults are disproportionately affected by CRC but are underrepresented in clinical trials. Hence, real-world data are crucial in guiding treatment in this population.

We conducted a retrospective cohort study involving patients aged ≥65 years diagnosed with CRC between 2015 and 2021 at King Abdullah Medical City, Makkah, Saudi Arabia. Clinical data, treatment patterns, and survival outcomes were analyzed.

Among 256 patients (mean age 74.7; 61.7% male), 75% had an Eastern Cooperative Oncology Group performance status of ≥2, and 31.2% presented with metastatic disease. Curative surgery was performed in 66.4% of patients, and 37.9% received adjuvant chemotherapy. Among patients experiencing metastatic disease, only 36% of patients received first-line therapy, and this proportion declined to 2% by fourth-line therapy. The median overall survival was 42 months, with a 5-year survival rate of 45%. Adjuvant chemotherapy (hazard ratio [HR] = 0.20; p = 0.001) and curative surgery were associated with improved survival, whereas late-stage disease (HR = 4.22; p = 0.003) predicted poorer outcomes. Age, sex, and body mass index were not significant predictors of survival.

Despite functional limitations, older patients benefit from standard therapies. These findings support function-based decision-making and routine integration of geriatric assessments into clinical care to improve outcomes in older patients with CRC.