Cancer treatment patterns and factors affecting receipt of treatment in older adults: results from the ASPREE Cancer Treatment Substudy (ACTS)

Abstract

Cancer treatment planning in older adults is complex and requires careful balancing of survival, quality of life benefits, and risk of treatment-related morbidity and toxicity. As a result, treatment selection in this cohort tend to differ from younger patients. However, there are very few studies describing cancer treatment patterns in older cohorts. We used data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial and the ASPREE Cancer Treatment Substudy (ACTS) to describe cancer treatment patterns in the elderly. We used a multivariate logistic regression model to identify factors affecting receipt of treatment. Of 1,893 eligible Australian and United States (US) participants with incident cancer, 1,569 (81%) received some form of cancer treatment. Non-metastatic breast cancers most frequently received treatment (98%), while haematological malignancy received the lowest rates of treatment (60%). Factors associated with not receiving treatment were older age (OR 0.94, 95% CI 0.91-0.96), residence in the US (OR 0.35, 95% CI 0.22-0.56), smoking (OR 0.60, 95% CI 0.37-0.98), and diabetes (OR 0.58, 95% CI 0.41-0.82). After adjustment for treatment patterns in sex-specific cancers, sex did not impact receipt of treatment. This study is one of the first describing cancer treatment patterns and factors affecting receipt of treatment across common cancer types in older adults. We found that most older adults with cancer received some form of cancer treatment, typically surgery or systemic therapy, although this varied with factors including cancer type, age, sex, and country of residence.