TEMPORAL AND REGIONAL VARIABILITY IN THE SURGICAL-TREATMENT OF CANCERAMONG OLDER-PEOPLE

OBJECTIVES: Numerous studies have documented that older individuals wi th cancer have been treated less aggressively than younger individuals . We utilized data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program to assess geographic vari ation in the effects of age on the surgical treatment of cancer and to examine temporal trends in the treatment of older people between 1973 and 1991. DESIGN: Ecological analyses comparing time trends of treatm ent in nine regions over a 19-year period. SETTING: Population-based d ata for nine geographic areas of the United States.PARTICIPANTS: Perso ns with incident cancer of the breast, colon, rectum, lung, ovary, ute rus, pancreas, and stomach residing in these regions during the select ed years. RESULTS: After age 64, the percentage of patients treated su rgically decreased with increasing age for every cancer site studied. Between 1973 and 1991, the likelihood of receiving surgery for cancers of the uterus, colon, rectum, ovary, and breast increased more rapidl y among patients ages 65 years and older than among those under age 65 . This relative increase occurred consistently across most geographic areas studied. For cancers of the lung, stomach, and pancreas, the eff ect of age on the likelihood of receiving surgery did not diminish thr ough the period under study.: CONCLUSIONS: Although older people remai n less likely to receive surgical therapy than younger persons, for so me important cancer sites the gap between the treatment of older and y ounger individuals narrowed from 1973 through 1991.