Anticancer treatment: what do older patients want?


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Martine Extermann

Moffitt Cancer Center, University of South Florida, Tampa, USA

Abstract

Anticancer treatment: what do older patients want?

Half of cancers occur beyond the age of 70. Treating cancer in older patients presents all the challenges of making treatment choices with individuals who are increasingly diverse in their health status, functionality, life experiences and desires. In this presentation we will review the data available on the treatment preferences of older cancer patients. Many series proceeded by patient questionnaires. One of the first studies along this model was among British lung cancer patients (all ages), by Slevin et al. It demonstrated that the cancer patients were much more willing to undertake chemotherapy for small benefits than the general population or their medical oncologist, let alone other health professionals. Using methods similar to that of Slevin, we demonstrated that older cancer patients are quite willing to undertake chemotherapy. Whereas in the American setting, older persons without cancer were just as willing, in the French context, they were less willing to do so. Therefore, in Europeans cultures, there is a quite marked shift in willingness once the diagnosis of cancer is made. Health care personnel should be aware of that cultural specificity, especially when it comes to advanced decision making. Older patients are also underrepresented in cancer trials. Studies have been conducted to assess whether a lesser willingness of older patients to participate was the reason. The Cancer and Leukemia Group B (CALGB) demonstrated that this is not the case. Whereas oncologists were offering trials to half of eligible young patients, they did so to only 35% of the older patients. Both sets of patients agreed to the trial half of the time it was proposed. More work needs to be done. For example few studies have studied alternate active strategies (radiation therapy versus surgery for example). Models allowing accurate prediction of both benefits and risks of treatment should be developed and might enhance the quality of the shared decisions by patients and health professionals.