Treatment Decisions In Older Patients Research Articles

Age and Functional Outcomes in Patients With Large Ischemic Stroke Receiving Endovascular Thrombectomy

Randomized clinical trials have demonstrated the efficacy and safety of endovascular thrombectomy for acute ischemic stroke with large infarct. Patients older than 80 years with large infarct are commonly encountered in clinical practice but underrepresented in randomized clinical trials. To provide an age-based analysis of functional outcomes in endovascular thrombectomy for acute ischemic strokes with large infarct. This retrospective multicenter cohort study included patients from the German Stroke Registry who received endovascular thrombectomy for acute ischemic stroke with large infarct at 1 of 25 German stroke centers between May 2015 and December 2021. Patients with acute ischemic stroke due to anterior circulation large vessel occlusion and large infarct were included. Large infarct was defined as an Alberta Stroke Program Early Computed Tomography Score of 0 to 5. Patients were subdivided by age to evaluate its association with functional outcomes. Age. Primary outcomes were independent ambulation (90-day modified Rankin Scale score of 0-3) and mortality (90-day modified Rankin Scale score of 6). A total of 408 patients with large infarct were included (217 women [53.2%]; median [IQR] age, 75 [64-83] years). The rate of independent ambulation decreased from 56.4% in patients aged 60 years and younger (44 of 78 patients) to 15.1% in patients older than 80 years (19 of 126 patients) (P < .001), while mortality increased from 15.4% (12 patients) to 64.3% (81 patients) (P < .001). Being older than 80 years was associated with lower rates of independent ambulation (adjusted odds ratio [aOR], 0.44; 95% CI, 0.23-0.82; P = .01) and higher mortality (aOR, 2.75; 95% CI, 1.61-4.72; P < .001). A final modified Thrombolysis in Cerebral Infarction grade of 2b or 3 was associated with higher rates of independent ambulation (aOR, 4.95; 95% CI, 2.14-11.43; P < .001), independent of age and without significant interaction (aOR, 0.69; 95% CI, 0.35-1.34; P = .27). In this cohort study of patients with acute ischemic stroke and large infarct, age was associated with functional outcomes. Patients older than 80 years had poor prognosis with high mortality but with sizeable differences depending on additional baseline and treatment characteristics. While it does not seem justified to apply a fixed upper age limit for endovascular thrombectomy, these results could assist clinicians in making informed treatment decisions in older patients with large ischemic stroke.

Clinically relevant gene signatures provide independent prognostic information in older breast cancer patients

BackgroundThe clinical utility of gene signatures in older breast cancer patients remains unclear. We aimed to determine signature prognostic capacity in this patient subgroup.MethodsResearch versions of the genomic grade index (GGI), 70-gene, recurrence score (RS), cell cycle score (CCS), PAM50 risk-of-recurrence proliferation (ROR-P), and PAM50 signatures were applied to 39 breast cancer datasets (N = 9583). After filtering on age ≥ 70 years, and the presence of estrogen receptor (ER) and survival data, 871 patients remained. Signature prognostic capacity was tested in all (n = 871), ER-positive/lymph node-positive (ER + /LN + , n = 335) and ER-positive/lymph node-negative (ER + /LN−, n = 374) patients using Kaplan–Meier and multivariable Cox-proportional hazard (PH) modelling.ResultsAll signatures were statistically significant in Kaplan–Meier analysis of all patients (Log-rank P < 0.001). This significance remained in multivariable analysis (Cox-PH, P ≤ 0.05). In ER + /LN + patients all signatures except PAM50 were significant in Kaplan–Meier analysis (Log-rank P ≤ 0.05) and remained so in multivariable analysis (Cox-PH, P ≤ 0.05). In ER + /LN− patients all except RS were significant in Kaplan–Meier analysis (Log-rank P ≤ 0.05) but only the 70-gene, CCS, ROR-P, and PAM50 signatures remained so in multivariable analysis (Cox-PH, P ≤ 0.05).ConclusionsWe found that gene signatures provide prognostic information in survival analyses of all, ER + /LN + and ER + /LN- older (≥ 70 years) breast cancer patients, suggesting a potential role in aiding treatment decisions in older patients.

Shared decision making in chronic kidney disease: a qualitative study of the impact of communication practices on treatment decisions for older patients

BackgroundEffective interpersonal communication is critical for shared decision-making (SDM). Previous SDM communication training in nephrology has lacked context-specific evidence from ethnographic analysis of SDM interactions with older patients considering treatment options of end stage kidney disease (ESKD). This study explores communication strategies in SDM discussions in nephrology, specifically focusing on older patients considering dialysis as kidney replacement therapy (KRT).MethodsWe conducted a qualitative study analysing naturally-occurring audio-recorded clinical interactions (n = 12) between Australian kidney doctors, patients aged 60+, and carers. Linguistic ethnography and qualitative socially-oriented functional approaches were used for analysis.ResultsTwo types of communication strategies emerged: (1) Managing and advancing treatment decisions: involving active checking of knowledge, clear explanations of options, and local issue resolution. (2) Pulling back: Deferring or delaying decisions through mixed messaging. Specifically for non-English speaking patients, pulling back was further characterised by communication challenges deferring decision-making including ineffective issue management, and reliance on family as interpreters. Age was not an explicit topic of discussion among participants when it came to making decisions about KRT but was highly relevant to treatment decision-making. Doctors appeared reluctant to broach non-dialysis conservative management, even when it appears clinically appropriate. Conservative care, an alternative to KRT suitable for older patients with co-morbidities, was only explicitly discussed when prompted by patients or carers.ConclusionsThe findings highlight the impact of different communication strategies on SDM discussions in nephrology. This study calls for linguistic-informed contextualised communication training and provides foundational evidence for nephrology-specific communication skills training in SDM for KRT among older patients. There is urgent need for doctors to become confident and competent in discussing non-dialysis conservative management. Further international research should explore naturally-occurring SDM interactions in nephrology with other vulnerable groups to enhance evidence and training integration.

THE RADIOTHERAPY USE BY OLDER CANCER PATIENTS IN PORTUGAL—2018 NATIONAL CANCER REGISTRY DATA

Abstract In Portugal, cancer is the second leading cause of death, accounting for 28544 in 2018, around 25% of all deaths. Radiotherapy (RT) will be required by around half of the cancer patients. Older patients should be treated with ultrahipofractionation and highly precise/accurate technology to reduce the treatment sessions and to avoid side effects which are important for their quality of life. Nowadays, there is a global lack of RT infrastructure/investment that compromises cancer outcomes. The aim of this study was to evaluate the RT coverage by older patients in Portugal. The authors examined the 2018 national cancer registry data regarding the RT use stratified by cancer site and age groups. A total of 14448 cancer registries regarding patients aged 70 y/o or over were included. We calculated the optimal use through the application of the optimal utilisation percentage of RT for each cancer site, published by European SocieTy for Radiotherapy and Oncology - Health Economics in Radiation Oncology (ESTRO-HERO) project. The ratio between optimal use and real RT use was 56%, 51%, 41%, and 36% for the patients aged 70-74, 75-79, 80-84, and 85+, respectively. We should interpret these results considering the complex older patients’ setting of multi-morbidity and geriatric syndromes. Furthermore, radiation oncologists face a lack of evidence that supports optimal treatment decisions for older patients. There is an urgent need for older adults’ inclusive clinical trials, measures to reduce ageism, improve access, and provide the cornerstone of quality cancer care for older adults - the geriatric assessment.

Impact of Geriatric Assessment on the Tolerability of Combination Chemotherapy in Older Patients with Advanced Cancer: A Matched-Pair Analysis

Because of their individual vulnerabilities, treatment decisions for older patients can be difficult. Geriatric assessment (GA) may help to select patients for systemic treatment, but its value is still unproven. Older cancer patients (≥65 years of age) with and without complex GA followed by discussion in the geriatric-oncologic conference, who had been treated in palliative intention with standard combination chemotherapy at the Evang. Kliniken Essen-Mitte, were retrospectively evaluated. All patients had been orally informed about the treatment options and had chosen chemotherapy beside supportive care. To reduce selection bias, the method of propensity-score matching was performed. Patient groups treated in the years 2011–2013 (without GA, group 1) and in the years 2014–2015 (with GA, group 2) were compared regarding different toxicity endpoints. The primary endpoint of the study was defined as numbers of patients with unplanned admission to the hospital or death during first-line chemotherapy and GA should reduce these events by 15%. Overall, 114 patients were evaluated in both groups. The median age was 74 years. Patients suffered from gastrointestinal carcinomas (47%), lung cancer (28%), breast cancer (12%), and other cancer types (3%). Consequently, most patients were treated with platinum-based (41%), fluoropyrimidine-based (35%), or anthracycline-based (13%) combination chemotherapy. In group 2, the events were numerically lower for all toxicity endpoints. The need for a premature stop of treatment was 54.4% in group 1 compared to 29.8% in group 2 (p < 0.01) and also the treatment-related mortality was significantly lower in group 2 (17.5% vs. 5.3%; p = 0.04). The primary endpoint, the rate of unplanned hospital admission, and death was 49.1% versus 35.1% (difference 14.0%), which did not reach the predefined border of 15%. There was a nonsignificant overall survival benefit in the group with GA (22.6 vs. 18.4 months). GA appears useful to better select older patients with advanced cancer for combination chemotherapy. The significant reduction of mortality during chemotherapy justifies the efforts and costs which need to be expended. To evaluate the effect of GA on overall survival, prospective trials are required.

Frailty and treatment decisions in older patients with vulvar cancer: A single-center cohort study

IntroductionVulvar cancer is a disease that mainly affects older women. Frailty is an important predictor of outcomes and geriatric assessment can help tailor treatment decisions and improve outcomes. This study aims to assess the prevalence of frailty in older women with vulvar cancer, and how it relates to integrated geriatric care and treatment according to the oncological guidelines. Materials and MethodsA single-center cohort study was performed, among patients 70 years and older, who were diagnosed with vulvar cancer at Leiden University Medical Center, between January 2012 and May 2020. Data on geriatric assessment, treatment decision-making and treatment-related outcomes were collected. ResultsOur study included 114 patients. Mean age was 79.7 years, and 52 patients (45.6%) were frail. Of the frail patients, 42.0% were referred to a geriatrician. In eight of these cases, the geriatrician was actively involved in weighing the benefit and harm of standard oncological treatment versus de-escalated treatment. Frailty, higher age, impairment in the somatic domain, cognitive impairment, and functional dependency were associated with referral to a geriatrician and with active involvement of a geriatrician in decision making. In 26 of frail patients (50.0%) oncological treatment was de-escalated. Frailty, higher age, impairment in the somatic domain, cognitive impairment, and functional dependency were associated with de-escalation of treatment. De-escalated treatment did not compromise survival. DiscussionFrailty is prevalent among older women with vulvar cancer and is associated with referral to a geriatrician and de-escalation of oncological treatment. While this reflects that it is deemed important to tailor treatment decision for frail patients, most frail patients are not routinely evaluated by a geriatrician. Further multidisciplinary collaboration and research is necessary to optimize tailored treatment decisions for this patient group.

Systemic anti-cancer therapy in older patients with gastrointestinal malignancies following comprehensive geriatric assessment: An age-based subgroup analysis.

796 Background: Comprehensive geriatric assessment (CGA) is recommended to inform treatment decisions in older patients with cancer. Patients ≥ 70 years are referred to the Geriatric Oncology and Liaison (GOAL) clinic in University Hospital Waterford, for a pre-treatment CGA, which includes assessment of mobility, cognitive, nutritional, functional, and psychological status, along with comprehensive geriatric pharmacological assessment. Informed treatment recommendations are made using CGA outcomes and risk assessed using the Cancer and Aging Research Group toxicity calculator. Limited information exists on treatment decisions based on age subgroups within the geriatric oncology population. Methods: Data from patients with gastrointestinal (GI) malignancies attending the GOAL clinic over a 3-year period to September 2022 were included. Patients ≥ 70 years with a G-8 (screening tool) score ≤14, and all patients aged ≥ 80 underwent CGA. An age-based subgroup analysis (&lt; 80 vs ≥ 80) of systemic anti-cancer therapy (SACT) decisions was performed using the Chi-square test. Results: In total, 206 patients with GI malignancies were assessed, comprising 67 (33%) patients with gastroesophageal cancer, 40 (19%) with pancreaticobiliary and 92 (45%) with colorectal cancer. 40% of patients were ≥ 80 years (n = 83). The majority of patients had stage III/IV disease (82%, n = 168). Across all groups, 58% (n = 120) of patients were treated with SACT, comprising 70% of those &lt; 80 (n = 86) and 41% (n= 34) of those ≥ 80. Across all stages (I-IV), patients ≥ 80 years were less likely to be treated with SACT compared to patients &lt; 80 years (p &lt; 0.01). There was no significant difference between age groups when comparing treatment intent (curative vs palliative) (p = 0.15). There was no significant difference between age groups for baseline dose reductions vs full dose (p = 0.18). Patients ≥ 80 years were less likely to receive polychemotherapy regimens in comparison with the &lt; 80 subgroup (p &lt; 0.01). Conclusions: Older patients with GI malignancies are a heterogeneous population. In the setting of a CGA, patients ≥ 80 years are less likely to receive SACT across any stage group, and are more likely to receive monochemotherapy regimens. The use of CGA ensures a considered and personalised approach to identify older adults most likely to benefit from active treatment and those where best supportive care alone is more appropriate.

Frailty in older Turkish cancer patients undergoing post-surgical adjuvant chemotherapy

Understanding the frailty levels of older patients undergoing surgery and chemotherapy will contribute to timely and reliable care practices and improve care outcomes. To determine the frailty of cancer patients who received chemotherapy treatment after surgery. This descriptive study included 192 Turkish patients aged over 60 years who received chemotherapy after surgery for cancer. Data were collected using a patient survey and the Edmonton Frailty Scale. The average age of the participants was 66.3±5.3 years. Around 40% (40.6%) of the sample were diagnosed with breast cancer. The Edmonton Frailty Scale score of the group was 6.6 (SD±3.7). A quarter of the sample (22.9%) were at risk of frailty. Frailty levels were higher in older individuals with gastrointestinal cancers and other cancer groups compared with patients with breast cancer (p<0.001); patients with additional chronic diseases other than cancer (p=0.004); and in those with a history of falling and hospitalisation in the past year (p<0.001). Older patients with gastrointestinal cancer, additional chronic disease and a history of falling and hospitalisation within the past year should be evaluated closely for frailty before and during chemotherapy. It is crucial to consider the patient's vulnerability when making care and treatment decisions for older patients with cancer. Understanding the frailty levels of older patients who undergo surgery and receive chemotherapy can help health professionals to decide on timely and reliable care practices and improve care outcomes.

SIOG2022-0079 - Frailty and Treatment Decisions in Older Patients with Vulvar Cancer

SIOG2022-0079 - Frailty and Treatment Decisions in Older Patients with Vulvar Cancer

Tailoring adjuvant chemotherapy by circulating tumor DNA (ctDNA) in older patients with stage II-III colon cancer

In most western countries, the median age of patients with CRC is around 70years. Although the benefit of adjuvant chemotherapy has been established in stage III colon cancer, it remains controversial in patients with stage II disease. Colon cancer treatment in older adults follows the same basic concepts as in younger patients. However, for older patients, who may have age-related organ function decline and comorbid conditions that may limit life expectancy, special attention must be paid to the risks of chemotherapy, including treatment-related toxicities and quality of life issues. Long-term toxicities are particular concerns in older patients who received adjuvant chemotherapy. In the high-risk frail patient population, avoiding adjuvant therapies in patients with negative circulating tumor DNA (ctDNA) group, could prevent treatmentrelated toxicities while preserving the quality of life. In the treatment paradigm of earlystage colon cancer, the promise of ctDNA lies in its potential to detect minimal residual disease following resection of the primary tumor, allowing precise risk assessment and ctDNA-guided adjuvant therapy. Future studies will determine whether this technique may tailor treatment for patients in the adjuvant setting. Subgroup analyses by age may yield data on the use of ctDNA in older patients. Integration of the ctDNA approach to geriatric assessment may complete the missing piece of the puzzle when making adjuvant treatment decisions in older patients with colon cancer.

The Prognostic Value of Eight Comorbidity Indices in Older Patients with Cancer: The ELCAPA Cohort Study.

Simple SummaryA prognostic assessment is crucial for making cancer treatment decisions. However, the frequent presence of comorbidities makes this assessment particularly challenging in older adults. Many comorbidity indices are available, but none have been developed for older patients with cancer. We assessed the prognostic performance (relative to one-year mortality) of eight comorbidity indices in a cohort of older patients with cancer. All the comorbidity indices were independently associated with 1-year mortality in the whole study population, and had very good discriminant ability. Among patients with metastatic cancer, only CIRS-G was independently associated with 1-year mortality.Background: A prognostic assessment is crucial for making cancer treatment decisions in older patients. We assessed the prognostic performance (relative to one-year mortality) of eight comorbidity indices in a cohort of older patients with cancer. Methods: We studied patients with cancer aged ≥70 included in the Elderly Cancer Patient (ELCAPA) cohort between 2007 and 2010. We assessed seven nonspecific indices (Charlson Comorbidity Index (CCI), three modified versions of the CCI, the Elixhauser Comorbidity Index, the Gagne index, and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G)) and the National Cancer Institute Comorbidity Index. Results: Overall, 510 patients were included. Among patients with nonmetastatic cancer, all the comorbidity indices were independently associated with 1-year mortality (adjusted hazard ratios (aHRs) of 1.44 to 2.51 for one standard deviation increment; p < 0.05 for all) and had very good discriminant ability (Harrell’s C > 0.8 for the eight indices), but were poorly calibrated. Among patients with metastatic cancer, only the CIRS-G was independently associated with 1-year mortality (aHR (95% confidence interval): 1.26 [1.06–1.50]). Discriminant ability was moderate (0.61 to 0.70) for the subsets of patients with metastatic cancer and colorectal cancer. Conclusion: Comorbidity indices had strong prognostic value and discriminative ability for one-year mortality in older patients with nonmetastatic cancer, although calibration was poor. In older patients with metastatic cancer, only the CIRS-G was predictive of one-year mortality.

Health outcome priorities in older patients with head and neck cancer

ObjectivesOlder patients with head and neck cancer often have comorbidity, have reduced life-expectancy and await intensive treatment. For the decision-making process, knowledge of a patient's health outcome prioritization is of paramount importance. We aim to study the health outcome priorities of older patients with head and neck cancer, and to evaluate whether general health, markers of physical, cognitive, and social functioning, and quality of life are associated with health outcome prioritization. Materials and MethodsPatients aged ≥70 years with head and neck cancer received a Comprehensive Geriatric Assessment and their priorities were assessed using the Outcome Prioritization Tool (OPT). Distribution of first priority, and associations with general health, markers of physical, cognitive, and social functioning, and quality of life were evaluated using ANOVA or chi-square. ResultsOf the 201 included patients, the OPT was available in 170 patients. The majority prioritized maintaining independence (n = 91, 53.3%), followed by extending life (n = 58, 34.1%), reducing pain (n = 14, 8.2%), and reducing other symptoms (n = 7, 4.1%). Housing situation, Body Mass Index, presence of musculoskeletal diseases, and quality of life were significantly related to prioritization of health outcomes. Reducing pain or other symptoms was more often prioritized by patients who lived alone, had a history of musculoskeletal problems, or had poor perceived quality of life. Age, sex, comorbidity, and markers of physical and cognitive functioning were not associated with health prioritization. ConclusionMaintaining independence is most often prioritized by older patients with head and neck cancer. In addition, we found that health outcome priorities of older patients are only limited based on general and specific health characteristics. We suggest to systematically discuss patients' priorities in order to facilitate complex treatment decisions in older patients with cancer.

Care of Seniors with Breast Cancer – Treatment Received and Refining Decision Making

AimsTreatment decisions for older patients with breast cancer are complex and evidence is largely extrapolated from younger populations. Frailty and comorbidity need to be considered. We studied the baseline characteristics and treatment decisions in older patients in Christchurch with breast cancer and assessed survival outcomes and prognostic/discriminatory performance of several tools. Materials and methodsWe searched the Canterbury Breast Cancer Registry and identified patients aged 70 years or older at diagnosis with invasive, non-metastatic breast cancer between 1 June 2009 and 30 June 2015. We retrieved demographics, treatment and outcome information. Overall survival and breast cancer-specific survival were estimated. Tools analysing performance status and comorbidity were assessed for their prognostic and discriminatory power. ResultsIn total, 440 patients were identified. Primary surgery was carried out for 362 patients (82.3%): breast-conserving surgery in 114 (of whom 88.6% received radiation therapy); mastectomy in 248 (of whom 24.6% received radiation). Hormone therapy was given for 265 (71.1%) patients with oestrogen receptor-positive cancers. Two hundred and seventy-four (62.3%) patients received full standard treatment, which was associated with significantly improved 5-year survival and 5-year breast cancer-specific survival. The median estimated overall survival was 8.2 years (95% confidence interval 7.3–9.1 years). Of those who died, 71.3% of deaths were due to causes other than breast cancer or unknown causes. The comorbidity-adjusted life expectancy (CALE) showed partial prognostic accuracy. CALE, Charlson and Eastern Cooperative Oncology Group tools all showed discriminatory value. ConclusionIn this population-based series of older patients with breast cancer, showing high levels of primary and adjuvant treatment, patients were more likely to die of causes other than breast cancer. Performance status and comorbidity tools showed prognostic and discriminatory potential in this population supporting their use in treatment decision making. CALE showed the most potential to improve treatment decisions but requires validation in this population to improve prognostic accuracy.

Abstract 11866: Cardiorespiratory Fitness and Mortality in Older Adults Age 60 to 90 Years

Introduction: With an aging population and advances in technology and surgical interventions, physicians are sometimes faced with difficult treatment decisions for older patients. Invasive treatment options may not be beneficial in older adults with limited survival. Chronological age alone does not fully reflect a patient’s prognosis and should not be the only factor used to guide treatment decisions. In this study, we assessed the association of cardiorespiratory fitness with all-cause mortality among adults age 60 to 90 years. Methods: This retrospective cohort study included patients age 60-90 years who underwent symptom-limited exercise treadmill testing at an integrated health system from 2011 to 2019. Patients were categorized into three age groups: 60-70 years, 70-80 years, and 80-90 years. Cardiovascular fitness was categorized into low fitness (&lt;5 METs), moderate fitness (5-10 METs), and high fitness (&gt;10 METs). Median follow-up was 3.5 years. Hazard ratios (HR) associated with exercise capacity were calculated using multivariable Cox regression models. Results: The study cohort included 40520 patients: 27021 (66.7%) age 60-70 years, 11638 (27.6%) age 70-80 years, and 1861 (4.6%) age 80-90 years. After treadmill testing, 3494 (8.6%) were categorized as low fitness, 21863 (54.0%) as moderate fitness, and 15163 (37.4%) as high fitness. Older age, female sex and presence of cardiovascular risk factors including hypertension, diabetes, and chronic kidney disease were associated with having low fitness. Low fitness and higher chronological age were independently associated with lower survival. Using the age 60-70 years group with high fitness as reference, the age 80-90 group with high fitness had better survival than their younger counterparts with low fitness (age 80-90 high fitness: HR 2.9, 95% CI 1.2-7.2; age 60-70 low fitness HR 4.3, 95% CI 3.1-5.9; age 70-80 low fitness HR 6.8, 95% CI 5.2-8.9). Conclusions: High cardiorespiratory fitness is a strong predictor of survival. When assessing a patient’s prognosis for long-term survival, chronological age alone should not be the only factor considered. Evaluation of cardiorespiratory fitness using treadmill testing may be useful for tailoring prognostic information.

P0326 - Real-life implementation and survival outcomes of geriatric-assessement-based guidelines for treatment decision in older patients with prostate cancer: The ELCAPA-26 cohort study

P0326 - Real-life implementation and survival outcomes of geriatric-assessement-based guidelines for treatment decision in older patients with prostate cancer: The ELCAPA-26 cohort study

Impact of a comprehensive geriatric assessment on decision-making in older patients with hematological malignancies.

Hematological treatment decisions in older adults with hematological malignancies are complex. Our objective is to study the impact of a comprehensive geriatric assessment on hematological treatment decision in older patients and the factors associated with change in treatment plan. We conducted a cross-sectional analysis of patients aged 65years and above with hematological malignancies, hospitalized between 2008 and 2019 at the University Cancer Institute of Toulouse. They were assessed by a geriatrician/nurse team using a comprehensive geriatric assessment (CGA). A penalized logistic regression model with elastic net regularization was used to identify factors associated with change in hematological treatment plan. A total of 424 patients were included. Main hematological malignancies were lymphoma (36.1 %), acute myeloid leukemia (26.9 %) and myelodysplastic syndrome (19.8%). Change in hematological treatment plan was suggested after CGA for 92 patients (21.7%). Factors associated with change in treatment plan were functional impairment according to ADL and IADL scale, mobility impairment, the presence of comorbidity defined by the Charlson score >1 and increasing age. A CGA has a significant impact on hematological treatment decision in older patients. Functional and mobility impairment, comorbidities and age are predictive factors of change in treatment plan.

Influence of Aging Processes on the Biology and Outcome of Multiple Myeloma

Influence of Aging Processes on the Biology and Outcome of Multiple Myeloma

Treatment decision-making in acute myeloid leukemia: a qualitative study of older adults and community oncologists

Little is known about the characteristics of patients, physicians, and organizations that influence treatment decisions in older patients with AML. We conducted qualitative interviews with community oncologists and older patients with AML to elicit factors that influence their treatment decision-making. Recruitment was done via purposive sampling and continued until theoretical saturation was reached, resulting in the inclusion of 15 patients and 15 oncologists. Participants’ responses were analyzed using directed content analysis. Oncologists and patients considered comorbidities, functional status, emotional health, cognition, and social factors when deciding treatment; most oncologists evaluated these using clinical gestalt. Sixty-seven percent of patients perceived that treatment was their only option and that they had not been offered a choice. In conclusion, treatment decision-making is complex and influenced by patient-related factors. These factors can be assessed as part of a geriatric assessment which can help oncologists better determine fitness and guide treatment decision-making.

P043: Prospective audit of the use of NABCOP fitness assessment form for breast cancer treatment decisions in older patients

Introduction: NABCOP was established to improve the quality of hospital care for older patients with breast cancer. A pilot study was previously done assessing the experience of breast units using the NABCOP fitness assessment form. Our study aim was to use the NABCOP form prospectively to assess patient health and fitness for breast cancer treatment decision.

Decision-making for older patients by Australian and New Zealand doctors with Advance Care Directives: a vignette-based study.

Little is known about doctors' decision-making patterns when using Advance Care Directives (ACDs), particularly for older patients in Australia and New Zealand. To determine the level of agreement among Australian and New Zealand doctors' decisions when using ACDs to guide treatment decisions for older patients. To evaluate factors that may affect decision-making including doctors' demographics, vignette complexity and Advance Care Directive (ACD) content. In December 2016-January 2017, a survey was distributed to doctors working within one tertiary hospital network in Melbourne and to doctors registered with the Australian and New Zealand Society of Geriatric Medicine. The survey comprised of three vignettes (1, 2, 3) presented with deidentified versions of genuine ACDs (A and B) volunteered by community members via a tertiary hospital ACD service. Five hundred and sixty doctors submitted completed surveys. The level of agreement between doctors when using ACDs varied by vignette complexity, ACD content, doctor speciality (P = 0.006 vignette 1 ACD A, P = 0.04 vignette 1 ACD B, P = 0.04 vignette 2 ACD A, P = 0.04 vignette 3 ACD B) and doctor seniority (P = 0.04 vignette 1 ACD A, P < 0.0001 vignette 2 ACD A). Australian and New Zealand doctors are infrequently exposed to ACDs in their work, 30% did not know the legal status of ACDs and majority of the cohort requested more education on ACDs. Despite the presence of an ACD, the level of agreement on treatment decisions for older patients when using ACDs varies by vignette complexity, ACD content, speciality and seniority of doctors.