Cancer is a disease of older people; 55% of invasive cancers in women in Ireland are diagnosed in those aged 65 and older. A report by the National Cancer Registry and Women’s Health Council revealed that older women (65 and over) diagnosed with cancer in Ireland during 1998-2001 were much less likely to receive cancer-directed treatment than younger women. This pattern was evident for every cancer investigated and almost every form of cancer-directed treatment. Since active treatment can be an important determinant of length of survival, risk of recurrence, and mortality, these findings have serious implications for the outcomes of older cancer patients.
The reasons for the lower treatment rates in older cancer patients are not known and have been little researched. Treatment may be less effective, and toxicity worse, in older patients. In addition, health status (e.g. comorbidities) and other adverse clinical factors may make treatment less clinically appropriate in older patients. However, these factors are unlikely to fully explain all of the disparity. It is possible that clinicians may have different views and attitudes towards treatment, and the benefits of treatment, in older than in younger patients. In addition older patients themselves have different preferences and beliefs regarding the value of treatment.
The project is investigating the reasons for the low rates of cancer-related treatment in older women in Ireland, using a mixed methods approach. The study has focussed on three cancers – colon, breast and ovarian – and involved three phases:
(1) survey of clinicians involved in cancer care;
(2) in-depth semi-structured interviews with consultants and nurses;
(3) in-depth semi-structured interviews with patients.
The rich data generated by the project will through light on the views, preferences and treatment-related decision making in older and younger patients; and clinicians' attitudes towards, and practices regarding, treatment of older and younger patients.
Data collection and analysis is complete and papers are in preparation.