title: How does older age influence oncologists' cancer management?
abstract: BACKGROUND
  Over half of new cancer cases occur in patients aged > or = 65 years. Many older patients can benefit from intensive cancer therapies, yet evidence suggests that this population is undertreated.
  
  
  METHODS
  To assess preferences and influential factors in geriatric cancer management, practicing U.S. medical oncologists completed a survey containing four detailed vignettes exploring colon, breast, lung, and prostate cancer treatment. Participants were randomly assigned one of two surveys with vignettes that were identical except for patient age (<65 years or >70 years).
  
  
  RESULTS
  Physicians in each survey group (n = 200) were demographically similar. Intensive therapy was significantly less likely to be recommended for an older than for a younger, but otherwise identical, patient in two of the scenarios. For a woman with metastatic colon cancer (Eastern Cooperative Oncology Group [ECOG] score, 1) for whom chemotherapy was recommended, nearly all oncologists chose an intensive regimen if the patient's age was 63; but if her age was 85, one fourth of the oncologists chose a less intensive treatment. Likewise, for stage IIA breast cancer (ECOG score, 0), 93% recommended intensive adjuvant treatment for a previously healthy patient aged 63; but only 66% said they would do so if the patient's age was 75. Oncologists commonly identified patient age as an influence on treatment choice, but were even more likely to cite performance status as a determining factor.
  
  
  CONCLUSIONS
  Advanced age can deter oncologists from choosing intensive cancer therapy, even if patients are highly functional and lack comorbidities. Education on tailoring cancer treatment and a greater use of comprehensive geriatric assessment may reduce cancer undertreatment in the geriatric population.
authors.affiliation: CE Outcomes, LLC, 107 Frankfurt Circle, Birmingham, Alabama 35211, USA. Jill.Foster@ceoutcomes.com
authors.forename: Jill A
authors.initials: JA
authors.lastname: Foster
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Salinas
authors.forename: Dorcas
authors.initials: D
authors.lastname: Mansell
authors.forename: James C
authors.initials: JC
authors.lastname: Williamson
authors.forename: Linda L
authors.initials: LL
authors.lastname: Casebeer
mesh_terms: D000367:Age Factors; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D015577:Geriatric Assessment; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000379:methods*; D009369:Neoplasms / Q000188:drug therapy / Q000628:therapy*; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D016896:Treatment Outcome