Elena Paillaud1,2, Florence Canoui-Poitrine2,3, Gwenaelle Varnier1, Narges Anfasi-Ebadi1, Ester Guery2,4, Olivier Saint-Jean5, Mathilde Gisselbrecht5, Thomas Aparicio6, Sylvie Bastuji-Garin2,3, Marie Laurent1,2, Philippe Caillet1,2. 1. Department of Internal and Geriatric Medicine, Assistance Publique - Hopitaux de Paris, Henri-Mondor Hospital, Paris, Île-de-France, France. 2. CEpiA (Clinical Epidemiology and Ageing), University Paris-Est Créteil (UPEC), EA 7376- IMRB, Creteil, France. 3. Department of Public Health, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France. 4. Clinical Research Unit (URC-Mondor), Assistance Publique - Hopitaux de Paris, Creteil, Île-de-France, France. 5. Geriatrics Department, Assistance Publique - Hopitaux de Paris, Hôpital Européen Georges Pompidou, Paris, Île-de-France, France. 6. Gastroenterology and Digestive Oncology Department, Assistance Publique - Hopitaux de Paris, Avicenne hospital, Bobigny, Île-de-France, France.
Abstract
Background: information of older patients with cancer is crucial to ensure optimal care. Objectives: to compare older patients with and without cancer regarding their preferences about medical information, decision-making and surrogate designation. Design: an intention-to-act questionnaire was completed by patients ≥70 y enroled in the ELderly CAncer PAtients cohort between January and June 2013 and by patients in the same age group enroled in a cross-sectional survey conducted in 2005 in acute geriatric wards. Setting: Henri-Mondor Teaching Hospital in the Paris conurbation, France. Results: the group with cancer had 133 patients [mean age, 79.6 ± 6.5 y; 54.9% women]. The main tumour sites were colorectal [24.1%], breast [23.3%] and prostate [15.8%]; 34.8% had metastases. All these patients wanted full information, 74.2% wanted to participate in decisions about their care, 87.2% would designate a family member to serve as a surrogate in life-threatening situations and 15% had already designated a surrogate. Compared to patients without cancer, those with cancer more often wanted to receive information in a life-threatening situation [93.6% versus 79.2%; P < 0.001]. Factors independently associated with patients wanting their informed consent to be obtained for all interventions were having children [adjusted odds ratio (aOR), 2.13; 95% confidence interval, 1.24; 3.66; P = 0.006], higher Mini Mental State Examination score [aORper point, 1.09; 1.02; 1.17], younger age in the group without cancer [aOR>82 y vs. ≤82 y, 0.50; 0.29-0.88] and being cancer-free [≤82 y, aOR, 0.30; 0.14-0.63; >82 y, aOR, 0.41; 0.17-0.97]. Conclusion: older patients with cancer expressed a strong preference for receiving information and participating in decisions about their care.
Background: information of older patients with cancer is crucial to ensure optimal care. Objectives: to compare older patients with and without cancer regarding their preferences about medical information, decision-making and surrogate designation. Design: an intention-to-act questionnaire was completed by patients ≥70 y enroled in the ELderly CAncerPAtients cohort between January and June 2013 and by patients in the same age group enroled in a cross-sectional survey conducted in 2005 in acute geriatric wards. Setting: Henri-Mondor Teaching Hospital in the Paris conurbation, France. Results: the group with cancer had 133 patients [mean age, 79.6 ± 6.5 y; 54.9% women]. The main tumour sites were colorectal [24.1%], breast [23.3%] and prostate [15.8%]; 34.8% had metastases. All these patients wanted full information, 74.2% wanted to participate in decisions about their care, 87.2% would designate a family member to serve as a surrogate in life-threatening situations and 15% had already designated a surrogate. Compared to patients without cancer, those with cancer more often wanted to receive information in a life-threatening situation [93.6% versus 79.2%; P < 0.001]. Factors independently associated with patients wanting their informed consent to be obtained for all interventions were having children [adjusted odds ratio (aOR), 2.13; 95% confidence interval, 1.24; 3.66; P = 0.006], higher Mini Mental State Examination score [aORper point, 1.09; 1.02; 1.17], younger age in the group without cancer [aOR>82 y vs. ≤82 y, 0.50; 0.29-0.88] and being cancer-free [≤82 y, aOR, 0.30; 0.14-0.63; >82 y, aOR, 0.41; 0.17-0.97]. Conclusion: older patients with cancer expressed a strong preference for receiving information and participating in decisions about their care.