Abstract
Background
Patient age is associated with poorer rectal cancer treatment compliance. However,
it is unknown whether left-digit bias (disproportionate influence of leftmost age
digit) influences this association.
Methods
The patients diagnosed with stage I–III rectal cancer between 2006 to 2017 in the
National Cancer Database were identified. The association between age and receipt
of guideline-adherent care was assessed using mixed-effects multivariable analyses.
Results
Among 97,960 patients, 46.2% received guideline-adherent overall treatment and 73.3%
underwent guideline-adherent surgical resection. Of those who underwent guideline-adherent
surgery, 86.4% received guideline-adherent radiotherapy and 56.6% received guideline-adherent
chemotherapy. After risk-adjustment, each decade increase in age was associated with
36% decreased odds of guideline-adherent therapy (odds ratio = 0.64, 95% confidence
interval = 0.63–0.65). Patients aged 58 to 59 (odds ratio = 1.15, 95% confidence interval =
1.02–1.27) and 78 to 79 (odds ratio = 1.28, 95% confidence interval = 1.08–1.51) had
higher odds of guideline-adherent overall treatment compared with patients aged 60
and 80, respectively. However, there were no significant differences in the receipt
of guideline-adherent treatment between patients aged 60 vs 61–62 and 80 vs 81–82.
Conclusion
Older patients with rectal cancer are less likely to receive guideline-adherent care,
and a left-digit bias is present. Geriatric assessment-guided treatment decisions
could help mitigate this bias.
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Article info
Publication history
Published online: July 14, 2022
Accepted:
April 29,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
