TY - JOUR
T1 - Community oncologists’ decision-making for treatment of older patients with cancer
AU - Mohile, Supriya G.
AU - Magnuson, Allison
AU - Pandya, Chintan
AU - Velarde, Carla
AU - Duberstein, Paul
AU - Hurria, Arti
AU - Loh, Kah Poh
AU - Wells, Megan
AU - Plumb, Sandy
AU - Gilmore, Nikesha
AU - Flannery, Marie
AU - Wittink, Marsha
AU - Epstein, Ronald
AU - Heckler, Charles E.
AU - Janelsins, Michelle
AU - Mustian, Karen
AU - Hopkins, Judith O.
AU - Liu, Jane
AU - Peri, Srihari
AU - Dale, William
N1 - Funding Information:
From aJames Wilmot Cancer Center, University of Rochester, Rochester, New York; bCity of Hope Cancer Center, Duarte, California; cSoutheast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; dHeartland Cancer Research NCORP, Decatur, Illinois; and eDelaware/Christiana Care NCORP, Newark, Delaware. Submitted August 10, 2017; accepted for publication October 9, 2017. Dr. Hurria has disclosed that she has received grant or research support from Celgene and Novartis, and has served as a consultant for Boehringer Ingelheim, Pierian Biosciences, and MJH Healthcare Holdings. The remaining authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors. This work was funded through a PCORI program contract (4634), UG1 CA189961 from the NCI, and R01 CA177592 from the NCI. This work was made possible by the generous donors to the WCI geriatric oncology philanthropy fund. All statements in this report, including its findings and conclusions, are solely those of the authors, do not necessarily represent the official views of the funding agencies, and do not necessarily represent the views of PCORI, its Board of Governors, or Methodology Committee. Author contributions: Study concept and design: Mohile, Magnuson, Pandya, Velarde, Hurria, Heckler, Dale. Data acquisition: Mohile, Magnuson, Velarde, Hurria, Wells, Plumb, Gilmore, Hopkins, Liu, Peri, Dale. Data analysis and interpretation: All authors. Manuscript preparation: All authors. Critical revision: All authors. Correspondence: Supriya G. Mohile, MD, MS, James P. Wilmot Cancer Center, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642. E-mail: supriya_mohile@urmc.rochester.edu
Publisher Copyright:
© JNCCN—Journal of the National Comprehensive Cancer Network
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Background: This study’s objectives were to describe community oncologists’ beliefs about and confidence with geriatric care and to determine whether geriatric-relevant information influences cancer treatment decisions. Methods: Community oncologists were recruited to participate in 2 multisite geriatric oncology trials. Participants shared their beliefs about and confidence in caring for older adults. They were also asked to make a first-line chemotherapy recommendation (combination vs single-agent vs no chemotherapy) for a hypothetical vignette of an older patient with advanced pancreatic cancer. Each oncologist received one randomly chosen vignette that varied on 3 variables: age (72/84 years), impaired function (yes/no), and cognitive impairment (yes/no). Other patient characteristics were held constant. Logistic regression models were used to identify associations between oncologist/vignette-patient characteristics and treatment decisions. Results: Oncologist response rate was 61% (n=305/498). Most oncologists agreed that “the care of older adults with cancer needs to be improved” (89%) and that “geriatrics training is essential” (72%). However, <25% were “very confident” in recognizing dementia or conducting a fall risk or functional assessment, and only 23% reported using the geriatric assessment in clinic. Each randomly varied patient characteristic was independently associated with the decision to treat: younger age (adjusted odds ratio [aOR], 5.01; 95% CI, 2.73–9.20), normal cognition (aOR, 5.42; 95% CI, 3.01–9.76), and being functionally intact (aOR, 3.85; 95% CI, 2.12–7.00). Accounting for all vignettes across all scenarios, 161 oncologists (52%) said they would offer chemotherapy. All variables were independently associated with prescribing single-agent over combination chemotherapy (older age: aOR, 3.22; 95% CI 1.43–7.25, impaired cognition: aOR, 3.13; 95% CI, 1.36–7.20, impaired function: aOR, 2.48; 95% CI, 1.12–5.72). Oncologists’ characteristics were not associated with decisions about providing chemotherapy. Conclusion: Geriatric-relevant information, when available, strongly influences community oncologists’ treatment decisions.
AB - Background: This study’s objectives were to describe community oncologists’ beliefs about and confidence with geriatric care and to determine whether geriatric-relevant information influences cancer treatment decisions. Methods: Community oncologists were recruited to participate in 2 multisite geriatric oncology trials. Participants shared their beliefs about and confidence in caring for older adults. They were also asked to make a first-line chemotherapy recommendation (combination vs single-agent vs no chemotherapy) for a hypothetical vignette of an older patient with advanced pancreatic cancer. Each oncologist received one randomly chosen vignette that varied on 3 variables: age (72/84 years), impaired function (yes/no), and cognitive impairment (yes/no). Other patient characteristics were held constant. Logistic regression models were used to identify associations between oncologist/vignette-patient characteristics and treatment decisions. Results: Oncologist response rate was 61% (n=305/498). Most oncologists agreed that “the care of older adults with cancer needs to be improved” (89%) and that “geriatrics training is essential” (72%). However, <25% were “very confident” in recognizing dementia or conducting a fall risk or functional assessment, and only 23% reported using the geriatric assessment in clinic. Each randomly varied patient characteristic was independently associated with the decision to treat: younger age (adjusted odds ratio [aOR], 5.01; 95% CI, 2.73–9.20), normal cognition (aOR, 5.42; 95% CI, 3.01–9.76), and being functionally intact (aOR, 3.85; 95% CI, 2.12–7.00). Accounting for all vignettes across all scenarios, 161 oncologists (52%) said they would offer chemotherapy. All variables were independently associated with prescribing single-agent over combination chemotherapy (older age: aOR, 3.22; 95% CI 1.43–7.25, impaired cognition: aOR, 3.13; 95% CI, 1.36–7.20, impaired function: aOR, 2.48; 95% CI, 1.12–5.72). Oncologists’ characteristics were not associated with decisions about providing chemotherapy. Conclusion: Geriatric-relevant information, when available, strongly influences community oncologists’ treatment decisions.
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U2 - 10.6004/jnccn.2017.7047
DO - 10.6004/jnccn.2017.7047
M3 - Article
C2 - 29523669
AN - SCOPUS:85044033942
SN - 1540-1405
VL - 16
SP - 301
EP - 309
JO - JNCCN Journal of the National Comprehensive Cancer Network
JF - JNCCN Journal of the National Comprehensive Cancer Network
IS - 3
ER -