Patient age tied to management of terminal cancer

The concerns of older patients with advanced cancer appear to be given more weight in treatment decisions than are those of their middle-age counterparts, according to a study of more than 1400 terminally ill patients.

“We approached this study with special concern for older cancer patients and were surprised to discover that the wishes of middle-aged patients may be more overlooked than those of older patients,” lead investigator Dr. Julia Hannum Rose told Reuters Health.Dr. Rose of Case Western Reserve University, Cleveland, Ohio, and colleagues examined data for 720 patients between 45 and 64 years old and 696 older patients. All of the subjects had been hospitalized with late-stage cancer and were part of a cohort with an estimated life expectancy of 6 months, they report in the December 15th issue of the Journal of Clinical Oncology.Physician estimates were accurate, but patients tended to be overly optimistic about future survival. Older patients were only slightly less optimistic than were the younger patients.These optimistic estimates were associated with preferences for life-prolonging treatment and cardiopulmonary resuscitation. However, fewer older patients opted for this approach.However, although most patients in both age groups also wished to avoid pain and discomfort, care consistent with this treatment goal was found only in the older group.It may be, suggest the investigators, that “among the middle-aged, more aggressive forms of treatment may be pursued regardless of patients’ preferences.” However, more aggressive care was not related to outcome.Overall, concluded Dr. Rose, “our results underline the importance of age-sensitive training for healthcare professionals and raise important questions about how age impacts communication and decision making by both providers and patients.”In an accompanying editorial, Drs. David B. Reuben and Arash Naeim of the University of California Los Angeles note that the patients in this study were treated at teaching hospitals, seriously ill and many were in intensive care units.The editorialists suggest that these patients may have been “on a relentless path to death” and that their preferences may have had “more symbolic than clinical meaning.”Nevertheless, they conclude that “it is hard to argue that late-stage cancer patients should ever receive care that is not in keeping with their preferences.”(Source: J Clin Oncol 2004;22:4869-4871,4907-4917: Reuters Health: Oncolink: January 2005.)