Multidisciplinary decision-making on chemotherapy for colorectal cancer: An age-based comparison

Hamaker, Marije E.; Rixtel, B. van; Thunnissen, P. L. M.; Oberndorff, Ardi; Smakman, Niels; Huinink, Daan ten Bokkel

doi:10.1016/j.jgo.2015.01.002

Cited by 25 publications

(17 citation statements)

References 19 publications

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“…In the same study, 35% of patients aged 70 years or more were not referred to oncologists, for the following reasons: chemotherapy was deemed inadvisable because of age, comorbidity/ physical condition, or lack of expected benefit in 23% of patients, failure to refer to an oncologist despite chemotherapy being deemed advisable in 7% of patients, and patient unwillingness to receive chemotherapy in 5% of patients. 31 As expected, functional status and comorbidities were associated with chemotherapy nonfeasibility. 11,32,33 Number of medications was associated with dose reduction and early discontinuation independently from functional status and CCI.…”

Section: External Validitysupporting

confidence: 57%

Chronological Age and Risk of Chemotherapy Nonfeasibility:

Laurent¹,

Guetz²,

Bastuji‐Garin³

et al. 2018

American Journal of Clinical Oncology

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Section: External Validitysupporting

confidence: 57%

Chronological Age and Risk of Chemotherapy Nonfeasibility:

Laurent¹,

Guetz²,

Bastuji‐Garin³

et al. 2018

American Journal of Clinical Oncology

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“…Prior studies comparing chemotherapy feasibility in older (≥70 years) with younger patients yielded conflicting results; some studies found lower feasibility rates for older patients (Hamaker et al, ; Moore et al, ; Muss et al, ; Schulkes et al, ), whereas others suggest similar feasibility rates across age groups (Berger et al, ; Blanchard et al, ; Folprecht et al, ). In addition, multiple prospective studies evaluated course of chemotherapy specifically in older patients with cancer (Aaldriks et al, ; Aparicio et al, ; Soubeyran et al, ; von Gruenigen et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, multiple prospective studies evaluated course of chemotherapy specifically in older patients with cancer (Aaldriks et al, ; Aparicio et al, ; Soubeyran et al, ; von Gruenigen et al, ). Primary and secondary adaptation rates (9%–67% and 0%–69% respectively) as well as completion rates (9%–90%) vary widely between studies, due to differences in definitions, study populations and treatment regimens (Aaldriks et al, ; Aparicio et al, ; Berger et al, ; Hamaker et al, ; Schulkes et al, ; von Gruenigen et al, ). Although this limits the comparability to our results, overall it can be said that treatment adaptations were more common in our oldest old population compared to both patients aged 70 years and older as well as compared to younger patients.…”

Section: Discussionmentioning

confidence: 99%

“…≥70 years) with younger patients yielded conflicting results; some studies found lower feasibility rates for older patientsMoore et al, 2009;Muss et al, 2007;Schulkes et al, 2018), whereas others suggest similar feasibility rates across age groups(Berger et al, 2017; Blanchard et al, 2011;Folprecht et al, 2008).In addition, multiple prospective studies evaluated course of chemotherapy specifically in older patients with cancer(Aaldriks et al, 2016; Aparicio et al, 2013;Soubeyran et al, 2012;von Gruenigen et al, 2017). Primary and secondary adaptation rates (9%-67% and 0%-69% respectively) as well as completion rates (9%-90%) vary widely between studies, due to differences in definitions, study populations and treatment regimens(Aaldriks et al, 2016; Aparicio et al, 2013;Berger et al, 2017;Hamaker et al, 2015;Schulkes et al, 2018;von Gruenigen et al, 2017). Although this limits the comparability to our results, overall it can be said that treatment adaptations were more common in our oldest old population compared to both patients aged 70 years and older as well as compared to younger patients.…”

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confidence: 99%

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Chemotherapy in the oldest old: Choices and outcomes

et al. 2019

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Treatment decision‐making in older patients with cancer is difficult due to a paucity of data evaluating chemotherapy tolerability in this population. We investigated the feasibility of chemotherapy in the oldest old and performed a singl‐centre retrospective analysis of patients aged ≥80 years initiating chemotherapy for one of five common solid malignancies or non‐Hodgkin lymphoma between 2010 and 2016. Treatment plan and course were extracted from medical files. Primary outcome was whether chemotherapy was completed according to plan, defined as a calculated relative dose intensity (RDI) ≥85%. A total of 104 patients receiving 129 chemotherapy lines were included. Median age at diagnosis was 82 years (range 80–94 years). Most patients (64%) received palliative intent chemotherapy. Primary and secondary chemotherapy adaptations were implemented in 63% and 65% of the cases, and hospitalisation occurred in a quarter. 52% of all cases completed chemotherapy according to plan. Almost half of the chemotherapy regimens started in the oldest old were not completed according to plan, despite frequently implemented upfront adaptations. The decision to start chemotherapy in these patients should be carefully considered. To improve decision‐making in current practice, there is a need for the implementation of validated tools assessing chemotherapy feasibility in these patients.

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“…To evaluate such systematic variations in preferences more closely, we conducted a number of post hoc analyses. Differences in the incidence of CRC and treatment decisions based on patients’ age and gender have been documented in the past 26–29. Therefore, we conducted subgroup analysis to determine whether age and gender were associated with systematic differences in patient preferences.…”

Section: Methodsmentioning

confidence: 99%

Patient and physician preferences for anticancer drugs for the treatment of metastatic colorectal cancer: a discrete-choice experiment

González¹,

Ogale²,

Morlock³

et al. 2017

CMAR

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ObjectiveMany publications describe preferences for colorectal cancer (CRC) screening; however, few studies elicited preferences for anticancer-drug treatment for metastatic CRC (mCRC). This study was designed to elicit preferences and risk tolerance among patients and oncologists in the USA for anticancer drugs to treat mCRC.Materials and methodsPatients aged 18 years or older with a self-reported diagnosis of mCRC and board-certified (or equivalent) oncologists who had treated patients with mCRC were recruited by two survey research companies from existing online patient panels in the USA. Additional oncologists were recruited from a list of US physicians. Patients and oncologists completed a discrete-choice experiment (DCE) survey. DCEs offer a systematic method of eliciting preferences and quantifying both the relative importance of treatment attributes and the tradeoffs respondents are willing to make among benefits and risks. Treatment attributes in the DCE were progression-free survival (PFS) and risks of severe papulopustular rash, serious hemorrhage, cardiopulmonary arrest, and gastrointestinal perforation. Patients’ and physicians’ maximum levels of acceptable treatment-related risks for two prespecified increases in efficacy were estimated.ResultsA total of 127 patients and 150 oncologists completed the survey. Relative preferences for the treatment attributes in the study were mostly consistent with the expectation that better clinical outcomes were preferred over worse clinical outcomes. Risk tolerance varied between patients and physicians. On average, physicians were willing to tolerate higher risks than patients, although these differences were mostly not statistically significant. Post hoc latent-class analyses revealed that some patients and physicians were unwilling to forgo any efficacy to avoid toxicities, while others were willing to make such tradeoffs.ConclusionDifferences in preferences between patients and physicians suggest that there is the potential for improvement in patients’ well-being. Initiating or enhancing discussions about patient tolerance for toxicities, such as skin rash and gastrointestinal perforations, may help prescribe treatments that entail more appropriate benefit–risk tradeoffs.

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Multidisciplinary decision-making on chemotherapy for colorectal cancer: An age-based comparison

Cited by 25 publications

References 19 publications

Chronological Age and Risk of Chemotherapy Nonfeasibility:

Chronological Age and Risk of Chemotherapy Nonfeasibility:

Chemotherapy in the oldest old: Choices and outcomes

Patient and physician preferences for anticancer drugs for the treatment of metastatic colorectal cancer: a discrete-choice experiment

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