Treatment decisions and outcomes in geriatric oncology

Abstract

Because of the ageing of the western population, the number of older patients with cancer is increasing. Therefore, physicians need to be able to optimally inform their older patients regarding different oncological treatment options. However, optimal treatment for this patient group is unknown due to different reasons. Firstly, scientific evidence for different oncological treatments for older patients specifically is scarce. Secondly, these patients form a heterogeneous group regarding their health status and degree of frailty and optimal treatment is likely to be dependent of this health status. Thirdly, older patients’ treatment preferences may differ from younger patients; quality of life is often of greater importance for older patients than prolongation of life while not many studies focus primarily on these outcomes. Thus, many questions regarding treatment and outcomes of older patients with cancer remain to be answered and this thesis aims to provide answers to some of these questions.

In summary, the results of this thesis show that many older patients with cancer did not receive guideline-adherent care and that they did not complete their oncological treatment according to plan. Primary and secondary treatment adaptations were frequently necessary. The G8, a short frailty screening tool, can be used to identify older patients with cancer who are at risk of poor treatment outcomes and who require a complete geriatric assessment. Older patients and those with comorbidity have higher risk of poorer health-realted quality of life. Because many older patients receive best supportive care only, early start of palliative care is important. Our results underline the importance of customized treatment for older patients with cancer based on shared decision making.