Older Adults Should Discuss Cancer Care Goals With Providers

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Many older adults with stage 4 cancer will prioritize quality of life (QOL) over survival time, highlighting the importance of conversations between patients and clinicians about goals of care, according to recent research findings presented at the 2023 American Society of Clinical Oncology (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, Ramy Sedhom, MD, said in an interview with Targeted Therapies in Oncology. “If prioritizing maintenance of independence, day-to-day functioning, and [QOL] are more important than the total number of days lived, make sure all… your physicians know that.”

Sedhom, who is the clinical director of palliative care at Penn Medicine Princeton Health and clinical assistant professor of 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, whereas 62% were vulnerable and 27% were frail. Additionally, 12% of the population experienced cognitive impairment, 22% had psychological challenges, and 39% had limited social support. Ninety-six percent of patients were enrolled in hospice care. Most patients (82%) prioritized QOL over time, and 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 QOL 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 end points 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.”

Sedhom explained that there are 2 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, and the second is weighing the 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 [QOL] 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 improves survival by only a few months (when studied in younger, healthier patients). The take-home point is that goals, values, and [priorities] 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 to meet those needs, rather than finding the most aggressive treatment that may inhibit QOL.

“I’d love to see quality measures around asking what is most important—to both patients and clinicians. 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…our everyday treatments impact quality of life.”

REFERENCES

1. Sedhom R, Donnelly R, Goldman NA, et al. What outcomes do older adults with cancer prioritize when asked? Presented at: ASCO Quality Care Symposium. October 27-28, 2023; Boston, MA