AOS24 Cancer physicians’ attitudes towards cancer treatment in geriatric patients in Singapore

Abstract

Background Geriatric oncology services are not routinely available in Singapore and most cancer physicians have little access to it. The management of elderly patients with cancer is often suboptimal with no standardised methods for decision making. Methods We surveyed practising cancer physicians in Singapore about their attitudes towards the treatment decision-making process for geriatric patients with cancer and compared their pattern of disclosure of the cancer diagnosis to older versus younger patients. Findings Fifty-seven cancer physicians participated—69% medical oncologists, 17% radiation oncologists, and 14% haematologists. Most physicians (52.6%) listed performance status (PS) as the top single factor affecting their treatment decision, followed by cancer type (23%) and the patient’s decision (11%). When asked to list the top five factors, they included PS (94.7%), comorbidities (75.4%), cancer stage (75.4%), cancer type (75.4%), patient’s decision (52.6%), and age (51%). Seventy-two per cent of physicians indicated a general lower inclination to treat an older patient aggressively, even if the patient was physically fit with minimal comorbidities; 52.6% and 89.5% opted for less intensive treatments for older patients in two hypothetical clinical scenarios of high-grade lymphoma and early breast cancer, respectively. Fifty-four per cent of physicians chose to disclose cancer diagnosis to family members instead of the older patient compared with the preference to disclose cancer diagnosis directly to the younger patient, citing family preference as the main reason. Most participants (61%) have never engaged a geriatrician’s help in treatment decisions, although 90% would welcome the introduction of a geriatric oncology programme. Interpretation Older age of the patient has a significant impact on the cancer physician’s treatment decision-making process. Many cancer physicians in Singapore still practice non-disclosure of cancer diagnosis to the older patient at the family’s request. Having a formal geriatric oncology programme in Singapore could help to optimise the management of the geriatric patient with cancer. The authors declared no conflicts of interest.