CANCER-TREATMENT AND AGE - PATIENT PERSPECTIVES

Background: Despite some evidence that age does not meaningfully influ ence the efficacy or toxicity of cancer treatment, older patients tend to receive less comprehensive cancer therapies. Purpose: We conducted a population-based study to evaluate the selection of cancer treatmen t among the elderly. Methods: Between September 1 and November 30, 199 0, we interviewed by telephone a sample of 628 female Wisconsin reside nts recently diagnosed with breast (507) or colorectal (121) cancer. T he women, aged 20-74 at the time of diagnosis, were identified through Wisconsin's statewide tumor registry. The approximately 30-minute lon g telephone interview, part of a larger study of cancer etiology, incl uded questions on treatment history, physician specialty, and reasons for the selection of specific therapies. Analyses compared the proport ion of subjects with various treatment characteristics according to ag e (<65 and greater-than-or-equal-to 65 years). In evaluating the effec t of age on selected therapies, we adjusted summary proportions for st age of disease using the indirect method. The Mantel-Haenszel chi squa re statistic was used to evaluate statistical significance of the diff erences in proportions. Results: After adjusting for stage of disease at diagnosis, substantial variation was observed in cancer treatment a ccording to age for both breast and colorectal cancer. Older women (gr eater-than-or-equal-to 65 years) with breast cancer were less likely t han younger women (<65 years) to have received conservative surgery, r adiation, and adjuvant therapy. Older women were, in fact, more likely than younger women to accept mastectomy (P = .03). Consultation with a medical or radiation oncologist was less common among older than you nger patients (57% versus 73%). Older women were also less likely to h ave alternative therapies presented to them (19% versus 31%). While ol der patients were less likely to have been offered adjuvant treatments , like chemotherapy (P<.01), they were also more likely than younger w omen to reject these treatments when offered (P = .01). These differen ces were observed in both breast and colorectal cancer patients. Regar dless of age, the most common reasons for not selecting treatments wer e physicians' recommendations and the desire for more comprehensive tr eatment. Concern about side effects, however, was more frequently repo rted by older women (P = .07). Conclusion and Implication: Patients' a ges influence the choice of treatment. Physicians offer older women wi th cancer different treatments from those offered to younger women and are less likely to recommend specialist consultation. Physicians' adv ice and description of toxicity may influence patients' selection of t reatment. However, older patients' concerns about the consequences of cancer treatment may also influence treatment choice.