Older patients with colorectal cancer are significantly less likely than younger patients to receive stage-appropriate adjuvant therapy. This study comprised separate surveys of colorectal cancer patients and colorectal surgeons to compare barriers to adjuvant chemotherapy use.
In the patient survey, a self-administered questionnaire was completed by patients who had undergone colorectal cancer surgery at a single tertiary referral hospital within the previous 24 months. Patients rated the importance of various factors in chemotherapy decision-making using a 10cm visual analogue scale. Factors were ranked in order of importance and results compared between older and younger patients. In the surgeon survey, a questionnaire was sent to all colorectal surgeons in Australia and New Zealand (n=146) to elicit opinions and self-reported practices. Likelihood of referring an older and a younger patient for adjuvant chemotherapy was compared in eight scenarios.
68 patients completed the survey (91% of those consenting). Factors that were significantly more important to older patients than younger patients were fear of dying (p<0.0001), health status before treatment (p=0.0003), and maintaining a good quality of life during treatment (p=0.005). Reducing the risk of cancer returning (mean 9.3; SD 0.5) and physician trust (mean 9.2; SD 0.5) were factors of highest importance for older patients. Travelling for treatment (mean 3.8; SD 2.8), cost (mean 5.5; SD 3.6), treatment duration (mean 5.8; SD 3.3) and family opinion (mean 6.7; SD 3.6) were rated lowest. Surgeons (n=102, 70% response rate) were significantly less likely to refer an older patient than a younger patient in all scenarios (all p<0.001). Distance to treatment, health status, and family support were factors that produced greatest differences in chemotherapy referral recommendations.
Surgeons’ and patients’ perceived barriers to treatment differ. Practical barriers such as distance to treatment were important to surgeons but not to older patients. Understanding barriers and individual patient preferences may help reduce care disparities among older people.