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Impact of patients' sex in assessments and treatment recommendations in an older adult cancer clinic

  • Isabel Tejero
    Affiliations
    Division of Geriatric Medicine and General Internal Medicine, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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  • Narhari Timilshina
    Affiliations
    Division of Geriatric Medicine and General Internal Medicine, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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  • Rana Jin
    Affiliations
    Nursing, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
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  • Susie Monginot
    Affiliations
    Nursing, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
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  • Arielle Berger
    Affiliations
    Division of Geriatric Medicine and General Internal Medicine, Department of Medicine, University Health Network, Toronto, Ontario, Canada

    Department of Medicine, University of Toronto, Toronto, Canada
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  • Lindy Romanovsky
    Affiliations
    Division of Geriatric Medicine and General Internal Medicine, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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  • Shabbir M.H. Alibhai
    Correspondence
    Corresponding author at: Department of Medicine, University Health Network; Professor, Department of Medicine, Institute of Health Policy, Management and Evaluation, and Institute of Medical Sciences, University of Toronto, Room EN14-214, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
    Affiliations
    Division of Geriatric Medicine and General Internal Medicine, Department of Medicine, University Health Network, Toronto, Ontario, Canada

    Department of Medicine, University of Toronto, Toronto, Canada

    Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
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Published:December 10, 2022DOI:https://doi.org/10.1016/j.jgo.2022.11.011

      Abstract

      Introduction

      In multiple settings, sex disparities have been seen in diagnosis, treatment, and outcomes. This study sought to determine whether there are sex differences in a geriatric oncology clinic concerning results of the comprehensive geriatric assessment (CGA) and treatment recommendations.

      Materials and Methods

      This is a retrospective cohort study including patients ≥65 years old referred for consultation on cancer treatment decision-making who underwent a CGA between July 2015 and December 2020, in a single Canadian academic geriatric oncology (GO) clinic. We examined differences by sex, stratified by disease site, stage, treatment intent, CGA results by domain, final treatment plan, and referrals for abnormal CGA findings. Differences were assessed using chi-square, Fisher's exact, or t-test as appropriate. Multivariate logistic regression was performed to examine whether sex impacted recommendations to reduce treatment intensity.

      Results

      In the study period, 328 patients were assessed in the GO clinic (mean age 81 years). The most common cancer types were gastrointestinal (42.1%), hematologic (18.3%), and head and neck (17.3%). More males than females were assessed in the GO clinic (62.2% versus 37.8%, respectively). This proportion did not change over time (p = 0.58). The GO clinic recommended to reduce treatment intensity in 140 cases (42.7%), with no difference between sexes in adjusted models (43.6% of females and 42.2% of males, p = 0.80). There were no differences in any CGA domain by sex. There were also no differences in referrals made by the GO clinic to optimize abnormal CGA domains by sex.

      Discussion

      Sex itself did not impact treatment decision-making, nor referrals to optimize abnormal CGA domains in our GO clinic using CGA-based care.

      Keywords

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