Clark DuMontier1,2, Kah Poh Loh3, Paul A Bain4, Rebecca A Silliman5, Tammy Hshieh1,6, Gregory A Abel6, Benjamin Djulbegovic7, Jane A Driver1,6,8, William Dale7. 1. Brigham and Women's Hospital, Boston, MA. 2. Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA. 3. James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY. 4. Harvard Countway Library, Boston, MA. 5. Boston University Medical Center, Boston, MA. 6. Dana-Farber Cancer Institute, Boston, MA. 7. City of Hope Comprehensive Cancer Center, Duarte, CA. 8. Veterans Affairs Boston Healthcare System, New England Geriatric Research Education and Clinical Center, Boston, MA.
Abstract
PURPOSE: The terms undertreatment and overtreatment are often used to describe inappropriate management of older adults with cancer. We conducted a comprehensive scoping review of the literature to clarify the meanings behind the use of the terms. METHODS: We searched PubMed (National Center for Biotechnology Information), Embase (Elsevier), and CINAHL (EBSCO) for titles and abstracts that included the terms undertreatment or overtreatment with regard to older adults with cancer. We included all types of articles, cancer types, and treatments. Definitions of undertreatment and overtreatment were extracted, and categories underlying these definitions were derived through qualitative analysis. Within a random subset of articles, C.D. and K.P.L. independently performed this analysis to determine final categories and then independently assigned these categories to assess inter-rater reliability. RESULTS: Articles using the terms undertreatment (n = 236), overtreatment (n = 71), or both (n = 51) met criteria for inclusion in our review (n = 256). Only 14 articles (5.5%) explicitly provided formal definitions; for the remaining, we inferred the implicit definitions from the terms' surrounding context. There was substantial agreement (κ = 0.81) between C.D. and K.P.L. in independently assigning categories of definitions within a random subset of 50 articles. Undertreatment most commonly implied less than recommended therapy (148; 62.7%) or less than recommended therapy associated with worse outcomes (88; 37.3%). Overtreatment most commonly implied intensive treatment of an older adult in whom the harms of treatment outweigh the benefits (38; 53.5%) or intensive treatment of a cancer not expected to affect an older adult in his/her remaining lifetime (33; 46.5%). CONCLUSION: Undertreatment and overtreatment of older adults with cancer are imprecisely defined concepts. We propose new, more rigorous definitions that account for both oncologic factors and geriatric domains.
PURPOSE: The terms undertreatment and overtreatment are often used to describe inappropriate management of older adults with cancer. We conducted a comprehensive scoping review of the literature to clarify the meanings behind the use of the terms. METHODS: We searched PubMed (National Center for Biotechnology Information), Embase (Elsevier), and CINAHL (EBSCO) for titles and abstracts that included the terms undertreatment or overtreatment with regard to older adults with cancer. We included all types of articles, cancer types, and treatments. Definitions of undertreatment and overtreatment were extracted, and categories underlying these definitions were derived through qualitative analysis. Within a random subset of articles, C.D. and K.P.L. independently performed this analysis to determine final categories and then independently assigned these categories to assess inter-rater reliability. RESULTS: Articles using the terms undertreatment (n = 236), overtreatment (n = 71), or both (n = 51) met criteria for inclusion in our review (n = 256). Only 14 articles (5.5%) explicitly provided formal definitions; for the remaining, we inferred the implicit definitions from the terms' surrounding context. There was substantial agreement (κ = 0.81) between C.D. and K.P.L. in independently assigning categories of definitions within a random subset of 50 articles. Undertreatment most commonly implied less than recommended therapy (148; 62.7%) or less than recommended therapy associated with worse outcomes (88; 37.3%). Overtreatment most commonly implied intensive treatment of an older adult in whom the harms of treatment outweigh the benefits (38; 53.5%) or intensive treatment of a cancer not expected to affect an older adult in his/her remaining lifetime (33; 46.5%). CONCLUSION: Undertreatment and overtreatment of older adults with cancer are imprecisely defined concepts. We propose new, more rigorous definitions that account for both oncologic factors and geriatric domains.
Authors: E C Inwald; O Ortmann; M Koller; F Zeman; F Hofstädter; M Evert; G Brockhoff; M Klinkhammer-Schalke Journal: Breast Cancer Res Treat Date: 2017-02-15 Impact factor: 4.872
Authors: Darryl Outlaw; Maya Abdallah; Luiz A Gil-Jr; Smith Giri; Tina Hsu; Jessica L Krok-Schoen; Gabor Liposits; Tânia Madureira; Joana Marinho; Ishwaria M Subbiah; Gina Tuch; Grant R Williams Journal: Semin Radiat Oncol Date: 2022-04 Impact factor: 5.934
Authors: Grant R Williams; Chen Dai; Smith Giri; Mustafa Al-Obaidi; Christian Harmon; Kelly M Kenzik; Andrew McDonald; Olumide Gbolahan; Darryl Outlaw; Moh'd Khushman; Joshua Richman; Smita Bhatia Journal: JCO Clin Cancer Inform Date: 2022-09
Authors: Aaron R Dezube; Lisa Cooper; Emanuele Mazzola; Daniel P Dolan; Daniel N Lee; Suden Kucukak; Luis E De Leon; Clark Dumontier; Bayonle Ademola; Emily Polhemus; Raphael Bueno; Abby White; Scott J Swanson; Michael T Jaklitsch; Laura Frain; Jon O Wee Journal: J Gastrointest Surg Date: 2022-03-31 Impact factor: 3.267
Authors: Clark DuMontier; Hajime Uno; Tammy Hshieh; Guohai Zhou; Richard Chen; Emily S Magnavita; Lee Mozessohn; Houman Javedan; Richard M Stone; Robert J Soiffer; Jane A Driver; Gregory A Abel Journal: Haematologica Date: 2022-05-01 Impact factor: 11.047
Authors: Andrew Hantel; Clark DuMontier; Oreofe O Odejide; Marlise R Luskin; Adam S Sperling; Tammy Hshieh; Richard Chen; Robert Soiffer; Jane A Driver; Gregory A Abel Journal: Cancer Date: 2020-11-25 Impact factor: 6.860
Authors: William Dale; Grant R Williams; Amy R MacKenzie; Enrique Soto-Perez-de-Celis; Ronald J Maggiore; Janette K Merrill; Sweatha Katta; Kimberly T Smith; Heidi D Klepin Journal: JCO Oncol Pract Date: 2020-10-15
Authors: Marie A Flannery; Eva Culakova; Beverly E Canin; Luke Peppone; Erika Ramsdale; Supriya G Mohile Journal: J Clin Oncol Date: 2021-05-27 Impact factor: 44.544