Do elderly cancer patients care about cure? Attitudes to radical gynecologic oncology surgery in the elderly

Objective. The aim of this study was to address the hypothesis of no differ ence between elderly and younger patients' desire for optimal surgery and d isease cure. Methods. The new ARGOSE questionnaire with established instruments was admi nistered to 189 gynecologic cancer patients (95 aged < 65, 57 aged 65-74, a nd 37 aged 75+ years). Results. Disease diagnosis differed between the < 65 years and 65+ years co horts (P < 0,001), but treatment modalities were similar (P = 0,28), Influe nces of family and friends and past experiences of cancer had little influe nce on treatment decisions. There was no difference between cohorts in desi re for surgery offering a chance of disease cure (P = 0,75), except that th e elderly desire cure more if treatment is associated with disfigurement th an do the young. (P = 0.029). The elderly believe more strongly than the yo ung that the elderly value cure (P < 0.001). Issues of sexuality and femini nity associated with gynecologic cancer and treatment are more important to younger patients (P < 0,001), The elderly support equality of care with re lation to age more strongly than the young. However, in a situation of reso urce limitation, inequality favoring the young is opposed less strongly by the elderly than by the young. Social desirability bias may have influenced this finding, All cohorts reported symptom palliation to be of secondary i mportance to treatments offering a possibility of cure (P = 0.26), The elde rly believe more strongly that doctors should make management decisions (P < 0.001). Conclusion. The elderly desire radical surgery and disease cure as strongly as the young. They are less likely to question their doctors' decisions an d are therefore vulnerable to physicians' age bias. There is no justificati on for rationing care on the basis of chronological age. (C) 2001 Academic Press.