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Published in: Supportive Care in Cancer 8/2010

01-08-2010 | Short Communication

Characteristics of older newly diagnosed cancer patients refusing cancer treatments

Authors: Martine T. E. Puts, Johanne Monette, Veronique Girre, Christina Wolfson, Michèle Monette, Gerald Batist, Howard Bergman

Published in: Supportive Care in Cancer | Issue 8/2010

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Abstract

Purpose

With the aging of the population, there will be an increase in the number of older adults diagnosed with cancer. Little is known about the characteristics of older newly diagnosed cancer patients who refuse cancer treatment and how often they refuse. The aim of this paper was to describe the health and functional status characteristics of patients who refused cancer treatment.

Methods

A prospective pilot study on health and vulnerability in older newly diagnosed cancer patients was conducted in the Segal Cancer Centre, Jewish General Hospital, Montreal, Canada. One hundred-twelve patients agreed to participate (response 72%). Health and functional status were assessed during the baseline interview; information on cancer treatment was obtained from the medical chart at baseline, 3 and 6 months follow-up. Descriptive techniques such as frequencies and means were used to describe the health and functional status of patients who refused treatment.

Results

Of the 112 participants, 17 (15.2%) refused cancer treatment partially or completely. Of those 17, 15 were women and 2 men. Fifteen participants refused a part of their treatment upfront. Two refused all further treatment after severe toxicity. The majority of participants refusing cancer treatment were women with breast cancer and they mostly refused adjuvant chemotherapy. Participants who refused often lived alone, were less often married/living common-law, had activities of daily living disability, and often had early disease.

Conclusion

The majority of older newly diagnosed cancer patients underwent the recommended cancer treatment but partial or complete cancer treatment refusal in older newly diagnosed cancer patients was not uncommon.
Literature
1.
go back to reference Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA (2009) Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 27:2758–2765CrossRefPubMed Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA (2009) Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 27:2758–2765CrossRefPubMed
2.
go back to reference American Medical Association (1999) Health literacy: report of the Council on Scientific Affairs. Ad hoc committee on health literacy for the Council on Scientific Affairs. JAMA 281:552–557CrossRef American Medical Association (1999) Health literacy: report of the Council on Scientific Affairs. Ad hoc committee on health literacy for the Council on Scientific Affairs. JAMA 281:552–557CrossRef
3.
go back to reference Amalraj S, Starkweather C, Nguyen C, Naeim A (2009) Health literacy, communication, and treatment decision-making in older cancer patients. Oncology (Williston Park) 23:369–375 Amalraj S, Starkweather C, Nguyen C, Naeim A (2009) Health literacy, communication, and treatment decision-making in older cancer patients. Oncology (Williston Park) 23:369–375
4.
go back to reference Rothman MD, Van Ness PH, O'Leary JR, Fried TR (2007) Refusal of medical and surgical interventions by older persons with advanced chronic disease. J Gen Intern Med 22:982–987CrossRefPubMed Rothman MD, Van Ness PH, O'Leary JR, Fried TR (2007) Refusal of medical and surgical interventions by older persons with advanced chronic disease. J Gen Intern Med 22:982–987CrossRefPubMed
5.
go back to reference Velanovich V, Gabel M, Walker EM, Doyle TJ, O'Bryan RM, Szymanski W et al (2002) Causes for the undertreatment of elderly breast cancer patients: tailoring treatments to individual patients. J Am Coll Surg 194:8–13CrossRefPubMed Velanovich V, Gabel M, Walker EM, Doyle TJ, O'Bryan RM, Szymanski W et al (2002) Causes for the undertreatment of elderly breast cancer patients: tailoring treatments to individual patients. J Am Coll Surg 194:8–13CrossRefPubMed
6.
go back to reference van Kleffens T, van Baarsen B, van Leeuwen E (2004) The medical practice of patient autonomy and cancer treatment refusals: a patients' and physicians' perspective. Soc Sci Med 58:2325–2336CrossRefPubMed van Kleffens T, van Baarsen B, van Leeuwen E (2004) The medical practice of patient autonomy and cancer treatment refusals: a patients' and physicians' perspective. Soc Sci Med 58:2325–2336CrossRefPubMed
7.
go back to reference Huijer M, van Leeuwen E (2000) Personal values and cancer treatment refusal. J Med Ethics 26:358–362CrossRefPubMed Huijer M, van Leeuwen E (2000) Personal values and cancer treatment refusal. J Med Ethics 26:358–362CrossRefPubMed
8.
go back to reference Verhoef MJ, Rose MS, White M, Balneaves LG (2008) Declining conventional cancer treatment and using complementary and alternative medicine: a problem or a challenge? Curr Oncol 15(Suppl 2):s101–s106PubMed Verhoef MJ, Rose MS, White M, Balneaves LG (2008) Declining conventional cancer treatment and using complementary and alternative medicine: a problem or a challenge? Curr Oncol 15(Suppl 2):s101–s106PubMed
9.
go back to reference White M, Verhoef M (2006) Cancer as part of the journey: the role of spirituality in the decision to decline conventional prostate cancer treatment and to use complementary and alternative medicine. Integr Cancer Ther 5:117–122CrossRefPubMed White M, Verhoef M (2006) Cancer as part of the journey: the role of spirituality in the decision to decline conventional prostate cancer treatment and to use complementary and alternative medicine. Integr Cancer Ther 5:117–122CrossRefPubMed
10.
go back to reference Montbriand MJ (1998) Abandoning biomedicine for alternate therapies: oncology patients' stories. Cancer Nurs 21:36–45CrossRefPubMed Montbriand MJ (1998) Abandoning biomedicine for alternate therapies: oncology patients' stories. Cancer Nurs 21:36–45CrossRefPubMed
11.
go back to reference Sharf BF, Stelljes LA, Gordon HS (2005) A little bitty spot and I'm a big man: patients' perspectives on refusing diagnosis or treatment for lung cancer. Psycho-oncology 14(1057–9249; 8):636–646CrossRefPubMed Sharf BF, Stelljes LA, Gordon HS (2005) A little bitty spot and I'm a big man: patients' perspectives on refusing diagnosis or treatment for lung cancer. Psycho-oncology 14(1057–9249; 8):636–646CrossRefPubMed
12.
go back to reference Sinding C, Wiernikowski J, Aronson J (2005) Cancer care from the perspectives of older women. Oncol Nurs Forum 32(1538–0688; 6):1169–1175CrossRefPubMed Sinding C, Wiernikowski J, Aronson J (2005) Cancer care from the perspectives of older women. Oncol Nurs Forum 32(1538–0688; 6):1169–1175CrossRefPubMed
13.
go back to reference Puts MT, Monette J, Girre V, Wolfson C, Monette M, Batist G et al (2009) Participation of older newly-diagnosed cancer patients in an observational prospective pilot study: an example of recruitment and retention. BMC Cancer 9(1):277. doi:10.1186/1471-2407-9-277 CrossRefPubMed Puts MT, Monette J, Girre V, Wolfson C, Monette M, Batist G et al (2009) Participation of older newly-diagnosed cancer patients in an observational prospective pilot study: an example of recruitment and retention. BMC Cancer 9(1):277. doi:10.​1186/​1471-2407-9-277 CrossRefPubMed
14.
go back to reference Collaborative Staging Task Force of the American Joint Committee on Cancer (2004) Collaborative staging manual and coding instructions, version 01.04.00. Chicago, IL: Jointly published by the American Joint Committee on Cancer (Chicago, IL) and U.S. Department of Health and Human Services (Bethesda, MD); 2004. Report No.: NIH Publication Number 04-5496 Collaborative Staging Task Force of the American Joint Committee on Cancer (2004) Collaborative staging manual and coding instructions, version 01.04.00. Chicago, IL: Jointly published by the American Joint Committee on Cancer (Chicago, IL) and U.S. Department of Health and Human Services (Bethesda, MD); 2004. Report No.: NIH Publication Number 04-5496
15.
go back to reference Carbone PP, Kaplan HS, Musshoff K, Smithers DW, Tubiana M (1971) Report of the committee on Hodgkin's disease staging classification. Cancer Res 31:1860–1861PubMed Carbone PP, Kaplan HS, Musshoff K, Smithers DW, Tubiana M (1971) Report of the committee on Hodgkin's disease staging classification. Cancer Res 31:1860–1861PubMed
16.
go back to reference Durie BG, Salmon SE (1975) A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer 36:842–854CrossRefPubMed Durie BG, Salmon SE (1975) A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer 36:842–854CrossRefPubMed
17.
go back to reference Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefPubMed Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefPubMed
18.
go back to reference Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I et al (2005) The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53:695–699CrossRefPubMed Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I et al (2005) The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53:695–699CrossRefPubMed
19.
go back to reference Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370CrossRefPubMed Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370CrossRefPubMed
20.
go back to reference Fillenbaum GG, Smyer MA (1981) The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. J Gerontol 36:428–434PubMed Fillenbaum GG, Smyer MA (1981) The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. J Gerontol 36:428–434PubMed
21.
go back to reference Katz S (1983) Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 31:721–727PubMed Katz S (1983) Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 31:721–727PubMed
22.
go back to reference Groll DL, To T, Bombardier C, Wright JG (2005) The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol 58:595–602CrossRefPubMed Groll DL, To T, Bombardier C, Wright JG (2005) The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol 58:595–602CrossRefPubMed
23.
go back to reference Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET et al (1982) Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol 5:649–655CrossRefPubMed Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET et al (1982) Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol 5:649–655CrossRefPubMed
24.
go back to reference Extermann M, Albrand G, Chen H, Zanetta S, Schonwetter R, Zulian GB et al (2003) Are older French patients as willing as older American patients to undertake chemotherapy? J Clin Oncol 21:3214–3219CrossRefPubMed Extermann M, Albrand G, Chen H, Zanetta S, Schonwetter R, Zulian GB et al (2003) Are older French patients as willing as older American patients to undertake chemotherapy? J Clin Oncol 21:3214–3219CrossRefPubMed
25.
go back to reference Jagsi R, Abrahamse P, Morrow M, Griggs JJ, Schwartz K, Katz SJ (2009) Postmastectomy radiotherapy for breast cancer: patterns, correlates, communication, and insights into the decision process. Cancer 115:1185–1193CrossRefPubMed Jagsi R, Abrahamse P, Morrow M, Griggs JJ, Schwartz K, Katz SJ (2009) Postmastectomy radiotherapy for breast cancer: patterns, correlates, communication, and insights into the decision process. Cancer 115:1185–1193CrossRefPubMed
Metadata
Title
Characteristics of older newly diagnosed cancer patients refusing cancer treatments
Authors
Martine T. E. Puts
Johanne Monette
Veronique Girre
Christina Wolfson
Michèle Monette
Gerald Batist
Howard Bergman
Publication date
01-08-2010
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 8/2010
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-010-0883-0

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