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Cancer Epidemiol. 2014 Aug;38(4):346-53. doi: 10.1016/j.canep.2014.05.002. Epub 2014 Jun 6.

Age differences in presentation, diagnosis pathway and management of colorectal cancer.

Author information

  • 1Unit of Research, Majorca Department of Primary Health Care, Balearic Institute of Health, Reina Esclaramunda 9, 07003 Palma de Mallorca, Spain. Electronic address: mesteva@ibsalut.caib.es.
  • 2Unit of Research, Majorca Department of Primary Health Care, Balearic Institute of Health, Reina Esclaramunda 9, 07003 Palma de Mallorca, Spain.
  • 3Majorca Cancer Registry, Department of Public Health, Balearic Department of Health, C/Jesús n 33, 07001 Palma de Mallorca, Spain.
  • 4Health Consorcium of Barcelona, Parc Sanitari Pere Virgili - Edifici Mestral, Esteve Terrades, 30, 08023 Barcelona, Spain.
  • 5Canal Imperial Primary Care Centre, Paseo Colon 4, Zaragoza 50006, Spain.
  • 6Serreria II Primary Care Centre, Valencia Institute of Health, C/Pedro de Valencia 28, 46022 Valencia, Spain.
  • 7Clinical Epidemiology and Biostatistics Unit, A Coruña University, Complexo Hospitalario Universitario A Coruña, Xubias de Arriba, 84, Hotel de los pacientes 7ª planta, 15006 A Coruña, Spain.
  • 8Nazareth Primary Care Centre, Parque Nazareth 16, 46024 Valencia, Spain.
  • 9Evaluation and Clinical Epidemiology Department, Hospital del Mar, Passeig Marítim 25-29, 08003 Barcelona, Spain.
  • 10Department of Gastroenterology, University Clinic Hospital of Valencia, Avda Blasco Ibañez 17, 46010 Valencia, Spain.
  • 11Lluis Saye Primary Care Centre, C/Torres i Amat 8, 08001 Barcelona, Spain.
  • 12Fraga Primary Health Center, C/Hermana Andresa 2, 22520 Fraga, Huesca, Spain.
  • 13Department of Gastroenterology, Hospital Can Misses, c/Corona, 32-36, 07800 Eivissa, Spain.
  • 14Department of Pathology, Hospital Miguel Servet, Paseo Isabel La Católica 1, Zaragoza, Spain.
  • 15Department of Psicology and Sociology. University of Zaragoza, Violante de Hungria 23, 50009 Zaragoza, Spain.
  • 16Department of Public Health, Balearic Department of Health, Camí de Jesus 33, 07005 Palma de Mallorca, Spain.



The gap in survival between older and younger European cancer patients is getting wider. It is possible that cancer in the elderly is being managed or treated differently than in their younger counterparts. This study aims to explore age disparities with respect to the clinical characteristics of the tumour, diagnostic pathway and treatment of colorectal cancer patients.


We conducted a multicenter cross sectional study in 5 Spanish regions. Consecutive incident cases of CRC were identified from pathology services.


From patient interviews, hospital and primary care clinical records, we collected data on symptoms, stage, doctors investigations, time duration to diagnosis/treatment, quality of care and treatment.


777 symptomatic cases, 154 were older than 80 years. Stage was similar by age group. General symptoms were more frequent in the eldest and abdominal symptoms in the youngest. No differences were found regarding perception of symptom seriousness and symptom disclosure between age groups as no longer duration to diagnosis or treatment was observed in the oldest groups. In primary care, only ultrasound is more frequently ordered in those <65 years. Those >80 years had a significantly higher proportion of iron testing and abdominal XR requested in hospital. We observed a high resection rate independently of age but less adjuvant chemotherapy in Stage III colon cancer, and of radiotherapy in stage II and III rectal cancer as age increases.


There are no relevant age disparities in the CRC diagnosis process with similar stage, duration to diagnosis, investigations and surgery. However, further improvements have to be made with respect to adjuvant therapy.

Copyright © 2014 Elsevier Ltd. All rights reserved.


Colorectal cancer; Early diagnosis; Elderly; Health services accessibility; Primary health care; Quality of health care; Secondary care; Treatment

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