Author:

Keywords:

Science & Technology, Life Sciences & Biomedicine, Oncology, age, cancer, elderly, COMPETING RISK ANALYSIS, TREATMENT CHOICE, RADICAL PROSTATECTOMY, AGE, RADIOTHERAPY, SURVIVAL, OLDER, MEN, MASTECTOMY, MANAGEMENT, Age Factors, Aged, Aged, 80 and over, Belgium, Breast Neoplasms, Comorbidity, Female, Health Care Surveys, Health Knowledge, Attitudes, Practice, Health Status, Humans, Male, Middle Aged, Physicians, Family, Practice Patterns, Physicians', Prostatic Neoplasms, 1112 Oncology and Carcinogenesis, Oncology & Carcinogenesis, Veterinary Sciences, 3211 Oncology and carcinogenesis

Abstract:

AIMS: Several publications have reported age-related differences in the management of people with cancer. Most data have been derived retrospectively from hospital or cancer-centre databases. The aim of the present study was to identify major decisional factors observed in general practitioner (GP) practices, outside the hospital setting, regarding the clinical management of patients with prostate and breast cancer. MATERIALS AND METHODS: During three national GP meetings in Belgium, questionnaires presenting two simulated patient cases were presented to GPs who were asked two questions: one regarding further staging and referral of the case and the second regarding the treatment of the case. A total of 678 questionnaires were distributed. GPs received two randomly selected cases each: a breast cancer history and a prostate cancer history. Three variables were assessed simultaneously: age, performance status and medical history (comorbidity). RESULTS: The analysis indicated that elderly patients were more likely to be referred for non-curative treatment (OR 13.71; 95% CI 5.67-33.12; P < 0.0001 for prostate cancer and OR 17.67; 95% CI 4.04-77.31; P < 0.0001 for breast cancer). The other variables (performance status and medical history) did not affect treatment orientation. However, GPs were prepared to seek assistance from oncologists in both cases, irrespective of the patient's age. CONCLUSION: Age seems to be more important among GPs in deciding how to manage cancer patients than performance status and comorbidity. This is a very common prejudice. They are, nevertheless, inclined to refer people with cancer to oncologists independently of the patient's age.