title: Deciding on adjuvant chemotherapy for elderly patients with stage III colon cancer: a qualitative insight into the perspectives of surgeons and medical oncologists.
abstract: OBJECTIVE
  The aim of this study is to identify doctor-related factors determining the decision-making for adjuvant chemotherapy for patients with stage III colon cancer aged ≥75years.
  
  
  METHODS
  21 surgeons and 15 medical oncologists from 10 community hospitals were asked to complete a short questionnaire including tick-box questions regarding motives for non-referral/non-treatment, consultation of geriatricians, chemotherapy schemes prescribed and an open question regarding tolerability of chemotherapy.
  
  
  RESULTS
  29 medical specialists returned a completed questionnaire (response 81%). The motives for non-referral/non-treatment reported most often were comorbidity/bad general health condition of the patient; surgical complications; and treatment offered but refused by patient/family. 39% of the surgeons and 55% of the medical oncologists reported consultation of a geriatrician in 2-30% of their decisions. CAPOX and capecitabine were reported by medical oncologists as the most frequently prescribed regimens. Factors that influenced the decision for monotherapy or combination therapy were comorbidity; general health condition of the patient; and toxicity profile of the chemotherapeutics. In general, medical oncologists defined grade ≤2 toxicities as tolerable, with the exception of neuropathy, for which grade ≤1 toxicity was accepted.
  
  
  CONCLUSIONS
  In case medical oncologists prescribe adjuvant chemotherapy to elderly patients with stage III colon cancer, the chemotherapy schemes used are in line with clinical guidelines and they agree on acceptable levels of toxicity. However, the variation among surgeons and medical oncologists in motives for non-referral, non-treatment and consultation of geriatricians when deciding on adjuvant chemotherapy for elderly patients with stage III colon cancer, shows the complexity and need for specific knowledge.
authors.affiliation: Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven, The Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands. Electronic address: f.vanerning@iknl.nl.
authors.forename: Felice N
authors.initials: FN
authors.lastname: van Erning
authors.affiliation: Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands; Department of Epidemiology, Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands.
authors.forename: Maryska L G
authors.initials: ML
authors.lastname: Janssen-Heijnen
authors.affiliation: Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Creemers
authors.affiliation: Department of Internal Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands.
authors.forename: Hans F M
authors.initials: HF
authors.lastname: Pruijt
authors.affiliation: Department of Geriatric Medicine, TweeSteden Hospital, Tilburg, The Netherlands.
authors.forename: Huub A A M
authors.initials: HA
authors.lastname: Maas
authors.affiliation: Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven, The Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Valery E P P
authors.initials: VE
authors.lastname: Lemmens
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D003110:Colonic Neoplasms / Q000188:drug therapy*; D003657:Decision Making; D005260:Female; D005853:Geriatrics; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009426:Netherlands; D012017:Referral and Consultation; D066231:Surgeons; D011795:Surveys and Questionnaires
keywords: Adjuvant chemotherapy; Chemotherapy-related toxicity; Colon cancer; Elderly; Geriatrics; Oncology; Referral; Treatment-related decision-making