Patients' age a factor in terminal cancer care

Among people with advanced cancer, the concerns of the elderly appear to be given more weight than are those of middle-aged patients, according to a study involving 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 AMN Health.

Rose, at Case Western Reserve University in 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 their doctors estimated that they had a life expectancy of 6 months. These estimates were accurate, but patients tended to be overly optimistic about their chances of longer 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, but fewer older patients opted for this approach, the investigators found.

Although most patients in both age groups also wished to avoid pain and discomfort, care consistent with this goal was found only in the older group, the team reports in the Journal of Clinical Oncology.

It may be, they suggest, that "among the middle-aged, more aggressive forms of treatment may be pursued regardless of patients' preferences." However, more aggressive care did not improve outcomes.

Overall, Rose concluded, "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 suggest that the patients in this study may have been "on a relentless path to death" and that their preferences may have had "more symbolic than clinical meaning."

Nevertheless, they say, "It is hard to argue that late-stage cancer patients should ever receive care that is not in keeping with their preferences."

SOURCE: Journal of Clinical Oncology, December 15, 2004.