The impact of age on multi-disciplinary team access and decision-making for patients diagnosed with colorectal cancer: a single regional hospital experience

Objective: To explore whether age impacts on multidisciplinary team (MDT) access and/or decision-making for patients diagnosed with colorectal cancer (CRC) in a regional setting. Methods: A retrospective audit of factors (identified from a systematic literature review) that impact on the CRC MDT. Data collected included non-identifying demographics, CRC stage, MDT referral outcomes and other treatment decision-making variables. Setting and participants: All patients with a CRC diagnosis (2010-2019) admitted to a single regional public hospital (n=449) in South Australia. Main outcomes measures: Key study factors were compared for younger (<75 years) and older age (>=75 years) at diagnosis. Results: For eligible patients (n=335), 87% of patients were referred to a MDT, with no difference between older (84%) and younger (89%) patients (n=335, p=0.343). However, for patients with advanced CRC (Stage III-IV), older patients were less likely to be referred to MDT (87% vs 96%) (n=164, p=0.045). Age-related MDT referral difference was also observed for patients with more complex disease (advanced stage plus comorbidities) (85% older vs 97% younger) (n=113), p=0.049). Although MDT adjuvant therapy recommendations were less likely for older patients with complex disease, there was no difference between older and younger patients without comorbidities (53% vs 57%, respectively) (n=61), p=1.000). Conclusions: Age did not appear to predict MDT access, but age-related disparities were evident for patients with advanced CRC +/- comorbidities. These findings might partly account for evidence of slower rates of CRC survival increases for older compared to younger patients.