Community Oncologists' Decision-Making for Treatment of Older Patients With Cancer

This study's objectives were to describe community oncologists' beliefs about and confidence with geriatric care and to determine whether geriatric-relevant information influences cancer treatment decisions.

Community oncologists were recruited to participate in 2 multisite geriatric oncology trials. Participants shared their beliefs about and confidence in caring for older adults. They were also asked to make a first-line chemotherapy recommendation (combination vs single-agent vs no chemotherapy) for a hypothetical vignette of an older patient with advanced pancreatic cancer. Each oncologist received one randomly chosen vignette that varied on 3 variables: age (72/84 years), impaired function (yes/no), and cognitive impairment (yes/no). Other patient characteristics were held constant. Logistic regression models were used to identify associations between oncologist/vignette-patient characteristics and treatment decisions.

Oncologist response rate was 61% (n=305/498). Most oncologists agreed that "the care of older adults with cancer needs to be improved" (89%) and that "geriatrics training is essential" (72%). However, <25% were "very confident" in recognizing dementia or conducting a fall risk or functional assessment, and only 23% reported using the geriatric assessment in clinic. Each randomly varied patient characteristic was independently associated with the decision to treat: younger age (adjusted odds ratio [aOR], 5.01; 95% CI, 2.73-9.20), normal cognition (aOR, 5.42; 95% CI, 3.01-9.76), and being functionally intact (aOR, 3.85; 95% CI, 2.12-7.00). Accounting for all vignettes across all scenarios, 161 oncologists (52%) said they would offer chemotherapy. All variables were independently associated with prescribing single-agent over combination chemotherapy (older age: aOR, 3.22; 95% CI 1.43-7.25, impaired cognition: aOR, 3.13; 95% CI, 1.36-7.20, impaired function: aOR, 2.48; 95% CI, 1.12-5.72). Oncologists' characteristics were not associated with decisions about providing chemotherapy.

Geriatric-relevant information, when available, strongly influences community oncologists' treatment decisions.

Author information
Mohile SG1, Magnuson A1, Pandya C1, Velarde C1, Duberstein P1, Hurria A1, Loh KP1, Wells M1, Plumb S1, Gilmore N1, Flannery M1, Wittink M1, Epstein R1, Heckler CE1, Janelsins M1, Mustian K1, Hopkins JO1, Liu J1, Peri S1, Dale W1.

1From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware.

J Natl Compr Canc Netw. 2018 Mar;16(3):301-309. doi: 10.6004/jnccn.2017.7047.
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