Aim:Elderly patients (pts) account for a large proportion of pts with metastatic colorectal cancer (mCRC). Despite this they are underrepresented in clinical trials and often undertreated. The purpose of this study is to review the patterns of care of elderly pts with mCRC in the community setting.

Methods:
Retrospective analysis of 507 elderly (age >/= 65 years (yrs)) pts with mCRC on the Treatment of Recurrent and Advanced Colorectal Cancer database enrolled between July 2009 - November 2012. Comprehensive clinical data collected prospectively on pts with mCRC from 14 sites across Australia. Pts were analysed according to age groups: 65-75, 75-85 & >85 yrs. Treatment patterns and intent, performance status (PS), and overall survival (OS) analysed by age cohorts. Kaplan-Meier method used for survival analysis.

Results:
In this cohort, 213 (42.0%), 216 (42.6%) and 78 (15.4%) pts were aged 65-75, 75-85 and >85 yrs respectively. Older patients were more likely to be female (30.5% vs 42.1% vs 52.6%) and have worse PS (PS>2: 18.3% vs 25.9% vs 48.7%). No differences in co-morbidity score, primary tumour site or resection rates between age groups. 358 (70.6%) elderly pts received chemotherapy. Chemotherapy use declined with increasing age (83.1% vs 70.8% vs 35.9%). Among very elderly (>85 yrs) pts who received chemotherapy (n=28), 12 (42.9%) received combination chemotherapy and 6 (21.4%) were given bevacizumab.
Median OS was 24.3, 17.7 and 11.3 months in the 65-75, 75-85 and >85 yrs age groups respectively. Pts receiving chemotherapy had significantly longer OS than those who did not (median OS 22.7 vs 6.4 months, HR 0.28 (95% CI 0.21-0.38, p<0.0001)).
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Conclusion:Multiple studies have confirmed the safety and efficacy of fluorouracil and bevacizumab but in our cohort, chemotherapy and bevacizumab appear to be underutilised in the elderly. Chart review planned to explore reasons for not administering chemotherapy