The influence of clinical assessment (including age) and geriatric assessment on treatment decisions in older patients with cancer.
OBJECTIVE
The aim of this prospective study in older patients with cancer was to evaluate how clinical assessment (including age) determines the physician's treatment decisions, and how geriatric assessment (GA) further influences these decisions.


METHODS
Patients aged ≥70years old with cancer were included if a new therapy was considered. All patients underwent a GA and results were communicated to the treating physician. After the final treatment decision, a predefined questionnaire was completed by the physician.


RESULTS
In total, 937 patients with median age of 76years old were included. A total of 902 (96.3%) questionnaires were completed by the treating physicians. In 381/902 patients (42.2%) clinical assessment led to a different treatment decision compared to younger patients without co-morbidities. This difference was most prominent for chemotherapy/targeted therapy decisions. In 505/902 cases (56%) the treating physician consulted GA results before the final treatment decision. In these patients, the treatment decision was influenced by clinical assessment in 44.2%. In 31/505 patients (6.1%) the GA further influenced treatment, mostly concerning chemotherapy/targeted therapy. In eight patients GA influenced the physician to choose a more aggressive chemotherapy.


CONCLUSIONS
Physicians use different treatment regimens in older versus younger patients, based on clinical assessment, including age. GA results further influence treatment decisions in a minority of patients and may trigger the use of less aggressive as well as more aggressive treatments. GA information is not always utilized by oncologists, indicating the need for better education and sensitization.
Department of Medical Oncology, Oncologisch Centrum, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium. Electronic address: lore.decoster@uzbrussel.be.
Lore
L
Decoster
Cindy
C
Kenis
Katrien
K
Van Puyvelde
Johan
J
Flamaing
Godelieve
G
Conings
Jacques
J
De Grève
Tony
T
Mets
Koen
K
Milisen
Jean Pierre
JP
Lobelle
Hans
H
Wildiers
D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D010347:Patient Care Planning; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011795:Surveys and Questionnaires