DETERMINANTS OF CANCER-THERAPY IN ELDERLY PATIENTS

Background. Older patients with cancer are less likely to receive defi nitive therapy, but the reasons for this are unclear. Methods. All peo ple aged 65 years or older living in six counties in New Mexico and di agnosed with breast, prostate, or colorectal cancer between May 15, 19 84 and May 15,1986 (N = 669) were interviewed to obtain information on demographics, socioeconomic status, functional status, social support , other medical conditions, and cognitive status. Cancer treatment inf ormation was obtained from the New Mexico Tumor Registry. Results. In univariate analyses, the following variables were associated significa ntly with nonreceipt of definitive therapy for cancer: advanced age, i mpairment in activities of daily living, low physical activity, decrea sed mental status, impaired access to transportation, and poor social support. In a multivariate analysis with the above variables along wit h measures of comorbidity, only advanced age and decreased mental stat us remained significant predictors of nonreceipt of definitive surgery , whereas the effects of impaired access to transportation and low phy sical activity remained relatively large but no longer were statistica lly significant. When receipt of surgery and receipt of radiation ther apy were considered separately, older age, limited access to transport ation, impaired functional status, and impaired mental status all sign ificantly predicted nonreceipt of radiation therapy, but not surgery. Conclusions. There is a decline with age in the percentage of adults w ith cancer who receive definitive therapy independent of other potenti ally explanatory factors such as comorbidity. In addition, decisions a bout radiation may be influenced by nonmedical, potentially correctabl e factors such as impaired access to transportation.