QS116 - Dementia and Colorectal Cancer: Exploring Demographics & Management Strategies

Sunday, June 2, 2024

10:27 AM – 10:30 AM ET, USA

Location: Room 327

Quick Shot Presenter(s)

Meghan E. Lark, MD (she/her/hers)

General Surgery Resident
Indiana University School of Medicine
Indiana University School of Medicine
Indianapolis, IN, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

Kristen N. Kaiser, MD (she/her/hers)

General Surgery Resident
Indiana University School of Medicine
Indiana University
Indianapolis, IN, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
HA

Hannah Allison, MA

Project Management Specialist
Indiana University School of Medicine
Indianapolis, Indiana, United States

Disclosure information not submitted.
SM

Sean McGuire, MD (he/him/his)

General Surgery Resident
Indiana University School of Medicine
Indiana University
Indianapolis, IN, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
TR

Tyler Robinson, MD

General Surgery Resident
Indiana University
Indianapolis, Indiana, United States

Disclosure information not submitted.
CF

Cyrus Feizpour, MD

General Surgery Resident
Indiana University School of Medicine
Indianapolis, Indiana, United States

Disclosure information not submitted.

Senior Author(s)

Sanjay Mohanty, MD (he/him/his)

Assistant Professor of Surgery
Indiana University School of Medicine
Indiana University School of Medicine
Indianapolis, IN, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Purpose/Background: As the number of elderly patients continues to rise, risk of cancer and dementia also increases. Previous studies have suggested that colorectal cancer (CRC) patients with dementia may experience worse outcomes, present with more advanced disease, and utilize less treatment modalities than CRC patients without dementia. We aim to use a population-based cohort of patients with CRC to compare patients with and without dementia and explore differences in management approaches.

Methods/Interventions: We used a population-based, statewide cancer registry that captured all gastrointestinal malignancies diagnosed from 2000-2020. We obtained a cohort of colorectal cancer patients by selecting for anatomical sites of cancer, including colon, appendiceal, rectal, and anal cancers. We then compared demographic characteristics, payor status, stage, therapy type, and survival between CRC patients with and without a diagnosis of dementia (ICD-9 and ICD-10 codes). A sub-set analysis was performed on patients 80 years and older. Kaplan-Meier methods were used to examine differences in survival.

Results/Outcomes: Of the 76,271 patients with colorectal cancer included in our cohort, 1,584 patients (2.1%) had a diagnosis of dementia. Patients with dementia were significantly older (79 vs. 68 years, p< 0.001) more likely to be female (56% vs. 50%, p< 0.001), Black (8.5% vs. 7.3%, p = 0.007), diagnosed in a metropolitan area (78% vs. 73%, p< 0.001), and have colon cancer (80% vs. 73%, p< 0.001). Stage at diagnosis was similar across patients with and without dementia. Patients without dementia were significantly more likely to undergo chemotherapy (25% vs. 16%), radiation (15% vs. 9.6%), and surgery (80% vs. 74%) (p < 0.001). Lastly, patients with dementia were more likely to be recorded as refusal of surgical (3.9% vs. 1.3%, p< 0.001) and radiation (1.8% vs. 0.9%, p< 0.001) treatments. Of 16,829 (22%) patients who were 80 years or older, 753 (4.5%) had dementia. Management differences in patients with and without dementia were similar in the older cohort. Patients with dementia remained more likely to refuse surgical treatment (6.3% vs. 3.4%, p< 0.001) if they were over the age of 80, but radiation no longer had a statistical difference in refusal. Survival analyses were significant for decreased survival in the dementia cohort in all patients and patients older than 80 years (Figure 1, p< 0.001).

Conclusion/Discussion: Our study describes characteristics of a large cohort of CRC patients with dementia. We found that dementia is associated with decreased treatment utilization and worse survival outcomes. Future studies will focus on provider-level variation and understanding reasons for outliers in the receipt of cancer-directed therapies and exploring survival benefit in dementia patients.