Cancer treatment decision-making among young adults with lung and colorectal cancer: a comparison with adults in middle age.
Our aim is to understand experiences with treatment decision-making among young adults with cancer.



We studied patients with lung cancer or colorectal cancer in the Cancer Care Outcomes Research and Surveillance Consortium, a prospective cohort study. We identified 148 young adult patients aged 21-40 years who completed baseline interview questions about cancer treatment decision-making; each was propensity score matched to three middle adult patients aged 41-60 years, for a cohort of 592 patients. Patients were asked about decision-making preferences, family involvement in decision-making, and worries about treatment. An ordinal logistic regression model evaluated factors associated with more treatment worries.



Young and middle-aged adults reported similar decision-making preferences (p = 0.80) and roles relative to physicians (p = 0.36). Although family involvement was similar in the age groups (p = 0.21), young adults were more likely to have dependent children in the home (60% younger versus 28% middle-aged adults, p < 0.001). Young adults reported more worries about time away from family (p = 0.002), and, in unadjusted analyses, more cancer treatment-related worries (mean number of responses of 'somewhat' or 'very' worried 2.5 for younger versus 2.2 for middle-aged adults, p = 0.02.) However, in adjusted analyses, worries were associated with the presence of dependent children in the home (odds ratio [OR] 1.55, 95% CI = 1.07-2.24, p = 0.02), rather than age.



Young adults involve doctors and family members in decisions at rates similar to middle-aged adults but experience more worries about time away from family. Patients with dependent children are especially likely to experience worries. Treatment decision-making strategies should be based on individual preferences and needs rather than age alone. Copyright © 2015 John Wiley & Sons, Ltd.
Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.|Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.
Jennifer W
JW
Mack
Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.
Angel
A
Cronin
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.|Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.
Karen
K
Fasciano
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.|Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.|Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Susan D
SD
Block
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.|Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
Nancy L
NL
Keating
D000328:Adult; D001007:Anxiety; D015179:Colorectal Neoplasms / Q000523:psychology / Q000628:therapy*; D032882:Comprehension; D003657:Decision Making; D005190:Family; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008175:Lung Neoplasms / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D057240:Patient Preference; D010817:Physician-Patient Relations; D057216:Propensity Score; D011446:Prospective Studies; D055815:Young Adult