Patient age and cancer treatment decisions - Patient and physician views

PURPOSE: The purpose of this study was to examine patient and physician fac tors influencing the decision to use adjuvant chemotherapy for stage III co lon cancer in elderly persons. DESCRIPTION or STUDY: A cross-sectional mailed population-based survey of p atients 65 years of age and older who had undergone surgical resection of s tage III colon cancer in Colorado between august 1995 and December 1997 wer e identified by the statewide cancer registry (n = 276) and their treating physicians (n = 232). A questionnaire about the determinants of colon cance r treatment decisions was mailed to all patients for whom physician permiss ion was granted (n = 119). A similar questionnaire was sent to treating phy sicians. RESULTS: Ninety-two physicians (internal medicine 23%; family medicine 12%; surgery 37%; and oncology 24%) and 67 patients (mean age 75.8 years; 55% w omen) completed surveys. Fifty-four (80.6%) of the patients had received ad juvant chemotherapy. The major determinants of receiving adjuvant chemother apy were having seen an oncologist (P = .003), being younger (P = .003), an d being married (P = .021). After controlling for other potential influence s, only having seen an oncologist (odds ratio 8.0; confidence interval 1.5- 43.1) remained significantly associated with the receipt of chemotherapy. P hysicians were more likely than patients to rank comorbid conditions (39.1% versus 3.0%, respectively; P < .001) and the medical literature (20.7% ver sus 4.5%, respectively; P = .004) as important factors in making treatment decisions, while patients were more likely than physicians to rank physicia n opinion (73.1% versus 26.1%, respectively; P = .001), family preference ( 31.3% versus 9.8%, respectively; P = .001), and family burden (10.4% versus 2.2%, respectively; P = .038). CLINICAL IMPLICATIONS: In this elderly population, patient age is not recog nized by patients or physicians as affecting the decision to use adjuvant c hemotherapy. Other biologic and social factors are important, however, and the perspectives of physicians and patients differ regarding their relative importance.