A retrospective analysis of patient characteristics and the treatment experience of elderly oncology patients in Kingston, Ontario, Canada

Abstract

20628 Background: A 2005 study of treatment practices of elderly patients diagnosed before 2000 in Ontario, concluded that age remains a cause of disparity in cancer delivery and that this has remained unchanged over a 30 year period (Journal of Clinical Oncology 23:3802–10). Methods: We performed a retrospective chart review of all elderly patients (age ≥ 75 yrs) referred to the Cancer Centre of Southeastern Ontario in 2006. Patients were identified by a computer search. We collected data on patient demographics (age, gender, marital status, Charlson comorbidity score, cancer type, stage) and treatment (type, intent, acceptance/refusal). Results: A total of 454 patients, representing 17% of all new referrals, were identified. Patient characteristics were as follows: median age 80.0 yrs (75–99), males 49%, married 44.3%, patients with Charlson comorbidity score ≥5 41%. The commonest cancer sites were: gastrointestinal (22%), breast (17%), genitourinary (16%) and lung (15%). 39% of patients had undergone surgery with curative intent; 35% were referred for consideration of palliative treatments. Treatment was discussed and/or recommended as follows: chemotherapy 44%, hormonal therapy 22%, radiation 62%. Acceptance rates were highest for hormonal therapy (92%), intermediate for radiation (77%) and lowest for chemotherapy (47%). 21% of patients did not receive any cancer treatment. In bivariate analysis, the following factors were associated with a higher probability of accepting therapy: chemotherapy - non-palliative intent (p< 0.001), lower Charlson score (≤5) (p=0.003), type of cancer (p<0.001); hormonal therapy - male gender (p=0.036); radiation - married status (p=0.056), age <80 yrs ((p=0.04). Conclusions: We conclude: 1) elderly patients represent a significant proportion of all new referrals to our centre; 2) a substantial portion are referred for consideration of palliative treatments for advanced disease; 3) although hormonal therapy and radiation are associated with high acceptance rates, acceptance rates for chemotherapy are substantially lower, especially in pts with higher Charlson comorbidity scores and in the palliative setting. No significant financial relationships to disclose.