Treatment decisions in older patients with colorectal cancer: the role of age and multidimensional function

Abstract

The aim of the study was to investigate the role of age and multidimensional functional status in treatment decisions in older patients with colorectal cancer. Three hundred and thirty-seven patients aged 58-95 years with adenocarcinoma of the colon or rectum were interviewed before and after treatment using the OARS Multidimensional Functional Assessment Questionnaire (OMFAQ), a self-reported severity of morbidity scale, and the Rotterdam Symptom Checklist (RSCL). The OMFAQ rates five dimensions of function: social resources, economic resources, mental and physical health and self-care capacity. The likelihood of patients with Duke's C colorectal cancer receiving adjuvant chemotherapy decreased significantly with age (P = 0.001, trend). Differences in treatment received were not explained by differences in morbidity, economic, mental or physical function, self-care capacity, or any of the RSCL measures. After controlling for age, Duke's C patients who received adjuvant chemotherapy were less impaired in social resources than Duke's C patients who did not (P = 0.06). No other significant pre-treatment differences in functional status were found. Differences in age and social resources exist between patients who do and do not receive adjuvant chemotherapy. Care should be taken to ensure that patients are not excluded from treatment with known survival benefits because of their age, and the question of providing appropriate social support during adjuvant chemotherapy should be re-examined.

Physician, Patient, and Contextual Factors Affecting Treatment Decisions in Older Adults With Cancer and Models of Decision Making: A Literature Review

“…The use of adjuvant chemotherapy was 80% for patients aged 65–69 years, 64% for 75–79 years, and 13% for 85–89 years in 3391 patients with no co-morbidities. These findings are supported by a prospective study which revealed that a smaller proportion of patients above the age of 75 received surgery with chemotherapy for colorectal cancer compared to those patients younger than 75 (Bailey, et al, 2003). Researchers of this study suggest that these groups of older patients should have received adjuvant therapy because of the fact that patients in their 70s and 80s continue to have a reasonable life expectancy (Bailey, et al, 2003).…”

“…These findings are supported by a prospective study which revealed that a smaller proportion of patients above the age of 75 received surgery with chemotherapy for colorectal cancer compared to those patients younger than 75 (Bailey, et al, 2003). Researchers of this study suggest that these groups of older patients should have received adjuvant therapy because of the fact that patients in their 70s and 80s continue to have a reasonable life expectancy (Bailey, et al, 2003). Because of the retrospective nature of Schrag et al study, it was hard to account for non-medical barriers such as financial and caregiver issues.…”

“…Lack of insurance, poor financial status, and geographical barriers are important contextual factors that can also influence treatment choice (Bailey, et al, 2003; Mandelblatt, Yabroff, & Kerner, 1999; Schrag, et al, 2001). The Naturalistic model offers a useful framework in understanding the role of patient’s context in treatment decision-making.…”

Patient, physician and contextual factors are influential in the treatment decision making of older adults newly diagnosed with symptomatic myeloma

“…A majority (70%) of the study participants reported that their age had influenced their treatment decision, with older men being more likely to eliminate a particular treatment option exclusively because of their advanced age. In addition, several studies have found that clinicians will either rule out particular treatments based on a patient's age or will give strong recommendations against particular treatments in patients with colorectal or breast cancer [25-29]. …”

Educational Preparation of Nurses Caring for Older People with Cancer: An International Perspective

“…Their families are also more likely to need psychosocial support during and perhaps beyond the cancer treatment trajectory. [3][4][5] Nurses play a leading role in ensuring that these elements of care are in place. However, they require skills and knowledge of common clinical issues that occur in old age to enable them to help the patient and family develop goals for treatment, care, and quality of life.…”