A National Survey of Treatment Practices for Elderly Cancer Patients in India.

Abstract

Background: Elderly cancer patients are underrepresented in cancer services utilization and clinical research in India. National data on providers' knowledge, attitude and practices with regard to elderly cancer patients is sparse and is urgently required to address needs of this vulnerable and growing population.Methods: A self administered questionnaire was mailed to nationally representative sample of practicing oncologists all over India. 74 Oncologists (Medical Oncologists-58%; Radiation Oncologists-25%; Surgical Oncologists-12%; allied fields-6%) responded out of > 250 mailed Questionnaires (response rate-29%).Results: Majority (52%) of respondents considered patients with chronological age of >60 years as elderly. Although 75%(median) of elderly patients receive some therapy, only 50% of early stage-potentially curable patients and a similar percentage of advanced stage-potentially incurable patients receive curative and palliative therapies respectively. Also, half of treated patients require modification in their treatment approach and only two-third of treated patients complete therapy. The existent barriers to treatment included poor performance status (51%), advanced stage (18%), co-morbidities (14%) and financial constraints (8%). Only 50% Oncologists always discussed and 31% always enrolled elderly patients in clinical trials. Inadequacies with respect to care and evidence based recommendations for elderly patients as compared to young patients were felt by 47% and 92% of respondents respectively. The need of separate trials for elderly and a separate discipline of Geriatric Oncology was voiced by 92% and 87% of participants respectively. Major differences in treatment practice between Hemato-oncologists and non Hemato-oncologists are highlighted in table-1.Conclusions: Treatment practices and clinical trial accrual of elderly cancer patients in India is far from optimal. Formation of a National Geriatric Oncology society with a focus on research and treatment in this vulnerable group may enhance the understanding and clinical care of this growing population.Table-1 :Differences in the treatment practice between Hemato-oncologists and non Hemato-oncologistsTreatment PracticeHemato-oncologists(%)Non Hemato-oncologists(%)Age cut-off for elderly ≥60 years5939Palliative therapy *6030Curative therapy *5075Discuss trials with patients4264Enroll patients in trials3621Felt inadequacy in care5239Felt inadequacy in evidence based recommendations9685Felt need for seperate trials9685*Patients given therapy as a percentage of those eligible