Treatment goals, desire for disclosure, and perception of cancer treatment outcomes in older patients with cancer: An observational study from a tertiary care center in India

Introduction

There is little information regarding the perceptions of older adults with cancer about intent of therapy, desire for disclosure of diagnosis and prognosis, treatment priorities, and influencing factors.

Materials and Methods

We conducted a retrospective analysis of a prospectively maintained database at the geriatric oncology clinic of the Tata Memorial Hospital, Mumbai (India) where older patients with cancer (aged ≥60 years) were referred by their primary treating oncologists. Our three objectives were to understand the goals of cancer-directed therapy, evaluate the proportion of patients who desired disclosure of diagnosis and prognosis, and assess the proportion of patients who did not accurately understand the intent of cancer-directed therapy. We assessed the association of demographic and clinical factors and the results of geriatric assessment with patients' perceived intent of therapy and their desire for disclosure of diagnosis and prognosis using chi-square test and multivariate logistic regression.

Results

Between November 2020 and December 2023, we enrolled 2599 patients. The median age was 67 years (IQR, 63–72), 77.7 % were male, and 62.6 % were being treated with palliative intent. Most patients (71.7 %) wanted a full disclosure of the diagnosis and prognosis; in 23.1 % of the cases, family members refused permission to disclose these details to the patients. Factors associated with a decreased desire for disclosure included palliative intent of therapy, female sex, illiteracy, performance status ≥2, and impaired function. Among patients receiving curative intent therapy, 79.3 % prioritized complete cure, 14.6 % prioritized quality of life (QoL)/symptom relief, and 5.1 % prioritized prolongation of life. Among patients receiving palliative intent therapy, 79.1 % prioritized QoL/symptom relief and 20.6 % prioritized prolongation of life. Misperception of intent of therapy was noted in 34.1 % of patients and was significantly higher in patients on palliative intent treatment (44.5 %) than patients receiving curative intent therapy (16.7 %). Factors associated with increased misperception of intent of therapy were female sex, illiteracy, and palliative intent therapy.

Discussion

Understanding the perceptions and priorities of older individuals with cancer will help to identify key areas of intervention to meaningfully improve shared decision making, harmonize cancer treatment, and empower patients to make appropriate decisions regarding their care.