Abstract
Introduction
We evaluated the effect of the inclusion of a geriatrician in the multidisciplinary
cancer team (MDT) on decision-making for chemotherapy with curative intent in older
patients with colorectal cancer.
Materials and Methods
We audited all patients aged 70 years and older with colorectal cancer discussed at
MDT meetings between January 2010 and July 2018; selection was limited to those patients
for whom guidelines recommended chemotherapy with curative intent as part of the primary
treatment. We assessed how treatment decisions came about, and what the course of
treatment was in the period before (2010−2013) and after (2014–2018) the geriatrician
joined the MDT meetings.
Results
There were 157 patients included: 80 patients from 2010 to 2013 and 77 patients from
2014 to 2018. Age was mentioned significantly less often as the reason to withhold
chemotherapy in the 2014–2018 cohort (10% vs 27% in 2010–2013, p = 0.04). Instead, patient preferences, physical condition, and comorbidities were the main
reasons stated for withholding chemotherapy. Although a similar proportion of patients
started chemotherapy in both cohorts, patients treated in 2014–2018 required many
fewer treatment adaptations and were thus more likely to complete their treatments
as planned.
Discussion
Over time and by incorporating a geriatrician's input, the multidisciplinary selection
of older patients with colorectal cancer for chemotherapy with curative intent has
improved. By basing decisions on an assessment of the patient's ability to tolerate
treatment rather than using a more general parameter such as age, both overtreatment
of not-so-fit patients and undertreatment of fit-but-old patients can be prevented.
Keywords
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References
- Cancer statistics from the Netherlands Cancer Registry.https://iknl.nl/nkr-cijfersDate: 2022
- Participation in cancer clinical trials: race-, sex-, and age-based disparities.JAMA. 2004; 291: 2270-2276https://doi.org/10.1001/jama.291.22.2720
- Designing therapeutic clinical trials for older and frail adults with cancer: U13 conference recommendations.J Clin Oncol. 2014; 32: 2587-2594https://doi.org/10.1200/jco.2013.55.0418
- Multidisciplinary decision-making on chemotherapy for colorectal cancer: an age-based comparison.J Geriatric Oncol. 2015; 6: 225-232https://doi.org/10.1016/j.jgo.2015.01.002
- Landelijke richtlijn met regionale toevoegingen versie 2.0, IKNL 2008 Rectumcarcinoom; Landelijke richtlijn met regionale toevoegingen versie 2.1.IKNL, 2008
- Use of comprehensive geriatric assessment in older cancer patients: recommendations form the task force on CGA of the International Society of Geriatric Oncology (SIOG).Crit Rev Oncol Hematol. 2005; 55: 241-252https://doi.org/10.1016/j.critrevonc.2005.06.003
- The value of geriatric assessment in predicting treatment tolerance and all-cause mortality in older patients with cancer.Oncologist. 2012; 17: 1439-1449https://doi.org/10.1634/theoncologist.2012-0186
- Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology.J Clin Oncol. 2018; 36: 2326-2347https://doi.org/10.1200/JCO.2018.78.8687
- Integration of geriatric assessment into routine oncologic care and advances in geriatric oncology: a young International Society of Geriatric Oncology Report of the 2020 American Society of Clinical Oncology.J Geriatr Oncol. 2020; 11: 1324-1328https://doi.org/10.1016/j.jgo.2020.07.009
- Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study.Lancet. 2021; 398: 1894-1904https://doi.org/10.1016/S0140-6736(21)01789-X
- Geriatric assessment in the management of older patients with cancer – a systematic review (update).J Geriatric Oncol. 2022; 13: 761-777https://doi.org/10.1016/j.jgo.2022.04.008
- Geriatric assessment and management in cancer.J Clin Oncol. 2021; 39: 2058-2067https://doi.org/10.1200/JCO.21.00089
- Effect of 3 to 5 year of scheduled CEA and CT follow-up to detect recurrence of colorectal cancer: the FACS randomized clinical trial.JAMA. 2014; 311: 263-270https://doi.org/10.1001/jama.2013.285718
Article info
Publication history
Published online: February 15, 2023
Accepted:
February 6,
2023
Received in revised form:
January 16,
2023
Received:
October 15,
2022
Identification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
