Oral Presentation COSA-IPOS Joint Scientific Meeting 2012

"Are age and self-reported health predictors of older incurable cancer patients' preferences for involvement in decisions about palliative chemotherapy and for receiving prognostic information?" (#42)

Martin HN Tattersall 1 , Lakshmi Venkateswaran 1 , George Szonyi 2
  1. University of Sydney, Sydney, NSW, Australia
  2. Geriatric Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia

Aims: The median age of patients at the first diagnosis of cancer in Australia is 67.8 yrs. In incurable cancer, the treatment goals include control of symptoms, and prolongation of survival. In older patients co-morbidities and cognitive impairment complicate treatment decision-making.

Methods: We performed a questionnaire-based exploratory study to investigate whether older cancer outpatient's health status predicted their information needs, decisional role preferences, and their oncologist's treatment recommendation. The Vulnerable Elders Survey 13 scores were used to assess health status. Patients’ participation preferences in decision-making were elicited using the Control Preference Scale and prognostic information preferences using response to the question: Did you wish to receive information from your doctor about how long you might live after being diagnosed with cancer?

Results: Fifty outpatients with advanced lung (n=30) or bowel cancer with mean age 66.9 years participated. Fourteen patients were aged >70 years. Thirteen patients (26%) had VES scores of 3 or greater, and 5 of these patients were >70 years. 26 patients wanted to be passive in decision-making, and 29 patients wanted prognostic information. Age and VES score did not predict patient's role preferences or desire for prognostic information. Oncologist's were less likely to recommend chemotherapy for patients > 70 years (25% vs 75%, p=0.04) and for those who had VES scores of 3 or above (20% vs 80%, p=0.02). Concordance between patients' participation preferences and oncologist perception was 54%.

Conclusions: Until there is more evidence from larger studies, oncologists should explicitly inquire about each of their patient's information and role preferences.