Older Adults Should Discuss Cancer Care Goals With Providers

Many older adults with stage 4 cancer will prioritize quality of life over survival time, highlighting the importance of conversations between patients and providers about goals of care, according to recent research presented at the 2023 ASCO Quality Care Symposium.

“Patients have so much challenging information to absorb, it is overwhelming. For older adults, it is important to ask not only about the efficacy of a treatment but also what do we know of its tolerability,” study author, Dr. Ramy Sedhom said in an interview with CURE®. “If prioritizing maintenance of independence, day-to-day functioning, and quality of life are more important than the total number of days lived, make sure all of your doctors know that.”

Sedhom, who is the medical director of Oncology and Palliative Care Penn Medicine Princeton Health and assistant professor of Clinical Medicine at the University of Pennsylvania, and his team assessed 171 patients aged 75 and older with a stage 4 solid cancer diagnosis. Eleven percent of the patients were deemed fit, while 62% were vulnerable and 27% were frail. Additionally, 12% of the population experienced cognitive impairment, while 22% had psychological health difficulties, 39% had limited social support and 29% were at risk for malnutrition. Ninety-six percent of patients were enrolled in hospice care.

Most patients (82%) prioritized quality of life over time, while 77% of patients expressed the goal of preserving their independence.

“Most of us who follow the growing literature in geriatric oncology would not be surprised to hear that most older adults prioritize function and quality of life over survival. What we found confirms previous findings,” Sedhom said. “What surprises me is the reality that leaders in our field are still slow to adopt endpoints in research studies, such as functional independence and quality of life, when it is clearly what is most important to the majority of older adults.”

READ MORE:End-of-Life Discussions Can ‘Lay Out a Roadmap’ of Patient Wishes and Avoid Unnecessary Cancer Care

Sedhom explained that there are two aspects of quality communication between patients and their care team in this situation. The first is understanding what is important to patients and their loved ones, while the second is weighing cost and benefits of different treatment options.

“When certain older adults with advanced comorbidity or frailty hear that a certain treatment may not improve their quality of life or how long they live, they wonder why we would recommend it,” Sedhom said. “Patients are also often surprised to hear that chemotherapy in certain incurable cancers improve survival by only a few months (when studied in younger, healthier patients). The take-home point is that goals, values and prioritize are unique in individual persons. It is our responsibility to elicit these values and align care with what is most important.”

Moving forward, Sedhom hopes that more emphasis is put on patient goals and desires, rather than finding the most aggressive treatment that may inhibit quality of life.

“I'd love to see quality measures around asking what is most important — to both patients and caregivers. These should not only be measured but perhaps incentivized by payers,” he said. “From a science perspective, we need to start including measures of treatment tolerability and quality of life measures in treatment trials. We have been asking to include older adults in clinical trials - this is important - and at the same time, even in younger patients, we are still not answering questions around how do our everyday treatments impact quality of life.”

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