Abstract
Background: Elderly cancer patients are underrepresented in cancer services utilization and clinical research in India. National data on providers’ knowledge, attitude and practices with regard to elderly cancer patients is sparse and is urgently required to address needs of this vulnerable and growing population.
Methods: A self administered questionnaire was mailed to nationally representative sample of practicing oncologists all over India. 74 Oncologists (Medical Oncologists-58%; Radiation Oncologists-25%; Surgical Oncologists-12%; allied fields-6%) responded out of > 250 mailed Questionnaires (response rate-29%).
Results: Majority (52%) of respondents considered patients with chronological age of >60 years as elderly. Although 75%(median) of elderly patients receive some therapy, only 50% of early stage-potentially curable patients and a similar percentage of advanced stage-potentially incurable patients receive curative and palliative therapies respectively. Also, half of treated patients require modification in their treatment approach and only two-third of treated patients complete therapy. The existent barriers to treatment included poor performance status (51%), advanced stage (18%), co-morbidities (14%) and financial constraints (8%). Only 50% Oncologists always discussed and 31% always enrolled elderly patients in clinical trials. Inadequacies with respect to care and evidence based recommendations for elderly patients as compared to young patients were felt by 47% and 92% of respondents respectively. The need of separate trials for elderly and a separate discipline of Geriatric Oncology was voiced by 92% and 87% of participants respectively. Major differences in treatment practice between Hemato-oncologists and non Hemato-oncologists are highlighted in table-1.
Conclusions: Treatment practices and clinical trial accrual of elderly cancer patients in India is far from optimal. Formation of a National Geriatric Oncology society with a focus on research and treatment in this vulnerable group may enhance the understanding and clinical care of this growing population.
Table-1 : Differences in the treatment practice between Hemato-oncologists and non Hemato-oncologists Treatment Practice Hemato-oncologists(%) Non Hemato-oncologists(%) *Patients given therapy as a percentage of those eligible Age cut-off for elderly ≥60 years 59 39 Palliative therapy * 60 30 Curative therapy * 50 75 Discuss trials with patients 42 64 Enroll patients in trials 36 21 Felt inadequacy in care 52 39 Felt inadequacy in evidence based recommendations 96 85 Felt need for seperate trials 96 85
Prophylaxis of infectious complications with colony-stimulating factors in adult cancer patients undergoing chemotherapy—evidence-based guidelines from the Infectious Diseases Working Party AGIHO of the German Society for Haematology and Medical Oncology (DGHO)