AGE AND CLINICAL DECISION-MAKING IN ONCOLOGY PATIENTS

Background: Ageism is a cultural bias that might inappropriately steer oncologists away from recommending aggressive treatments for older pa tients. The extent to which older patients might prefer less aggressiv e cancer therapies is unknown. Our lack of knowledge about patients' p ersonal preferences for therapy may perpetuate this bias. Purpose: We conducted a study to determine 1) if age influences patient acceptance of cancer therapy and 2) if the older patients would be more or less likely to trade increased survival for maintaining quality of life tha n their younger counterparts. Methods: Using an interview format, 244 cancer patients of all ages treated at a tertiary care cancer center r ead two sets of hypothetical vignettes. The first set consisted of fou r vignettes that varied in terms of stage of disease and treatment tox icity. Patients were asked to make hypothetical decisions about treatm ent given with respect to varying levels of either increasing cure or extending survival. The second set of vignettes presumed acceptance of cancer therapy. Within each vignette, two hypothetical treatments (mi ld versus severe) with different probabilities of 1-year survival were contrasted. The point at which patients shifted preferences from a tr eatment with mild versus severe side effects was the dependent measure . Mixed analysis of variance (ANOVA) procedures (F test) assessed the impact of age (<65 years versus greater than or equal to 65 years) and patient disease stage (early versus advanced) on hypothetical decisio ns about treatment. All P values are two sided. Results: In the treatm ent-preference vignettes, there was no effect of either age [F(1,239) = 2.14; P =.14] or patient stage [F(1,239) = .40; P = .53] on treatmen t acceptance. Older adults were as likely as their younger counterpart s to agree to chemotherapy for both curative and control purposes. In the switch-point vignettes, younger adults switched to a more toxic tr eatment to gain survival advantage at an earlier point than the older patients in both the early-disease vignette F(1,232) = 3.88; P = .05] and the advanced-disease vignette [F(1,232) 4.43; P = .036]. There was neither an effect of disease stage on treatment decisions nor an inte raction between disease stage and age. Conclusions and Implications: I n a tertiary care setting, older adults do not differ from their young er counterparts in terms of acceptance of chemotherapy. However, when treatment is presumed, they differ in terms of willingness to trade su rvival for current quality of life. Generalization of findings is limi ted by the relatively small sample of older adults (n = 43) and the re ferral population from which the sample was drawn. Replication with a larger older adult sample in a community setting is needed.