title: Multidisciplinary decision-making on chemotherapy for colorectal cancer: an age-based comparison.
abstract: BACKGROUND
  With the ageing of society, optimising decision-making for older patients with cancer becomes increasingly important. A first step is awareness of current clinical practice. We analysed how treatment decisions regarding chemotherapy for older and younger patients with colorectal cancer are currently being made by the multidisciplinary team, the oncologist and the patient.
  
  
  METHODS
  A total of 316 patients with colorectal cancer (median age 68.3 years), discussed at the multidisciplinary gastrointestinal oncology team meetings between 2010 and 2013, were reviewed to select patients for whom guidelines recommended chemotherapy. Multidisciplinary decision-making and subsequent clinical course were extracted from medical files.
  
  
  RESULTS
  The multidisciplinary team recommended chemotherapy in 97% of younger patients treated with curative intent, compared to 65% of older patients; 86% of younger patients and 42% of older patients subsequently received chemotherapy. In a palliative setting, the multidisciplinary team recommended chemotherapy in 98% of younger and 69% of older patients and 81% and 45%, respectively, subsequently received this treatment. In addition to comorbidity and the patient's physical condition, chronological age was an important reason for withholding chemotherapy. When older patients did receive chemotherapy, reduced intensity regimens were often effectuated.
  
  
  CONCLUSIONS
  Multidisciplinary decision-making regarding chemotherapy for older patients with colorectal cancer is still frequently based on clinical impressions, preconceptions or chronological age alone. Rather, treatment decisions should be made after thorough evaluation of the patient's health status across multiple domains, either by a geriatrician or within the oncology team itself. Given the preference-sensitive nature of chemotherapy decisions in the elderly, shared decision-making should be strived for whenever possible.
authors: Department of Geriatric Medicine, Diakonessenhuis, Utrecht, The Netherlands. Electronic address: mhamaker@diakhuis.nl.
authors: Marije E
authors: ME
authors: Hamaker
authors: Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands.
authors: Bert
authors: B
authors: van Rixtel
authors: Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands.
authors: Peter
authors: P
authors: Thunnissen
authors: Department of Gastro-enterology, Diakonessenhuis, Utrecht, The Netherlands.
authors: Ardi H
authors: AH
authors: Oberndorff
authors: Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands.
authors: Niels
authors: N
authors: Smakman
authors: Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands.
authors: Daan
authors: D
authors: Ten Bokkel Huinink
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D003657:Decision Making; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009426:Netherlands; D018802:Patient-Centered Care
keywords: Chemotherapy; Colorectal cancer; Decision making; Elderly