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Supportive Care in Cancer

, Volume 18, Issue 8, pp 969–974 | Cite as

Characteristics of older newly diagnosed cancer patients refusing cancer treatments

  • Martine T. E. Puts
  • Johanne Monette
  • Veronique Girre
  • Christina Wolfson
  • Michèle Monette
  • Gerald Batist
  • Howard Bergman
Short Communication

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.

Keywords

Treatment refusal Frail elderly Geriatric oncology Geriatric assessment Functional status Cancer treatment Prospective cohort study 

Notes

Acknowledgments

We thank all of the participants who gave of their time during a very difficult period of their life to participate in our study. In addition we very much appreciate the support of staff and volunteers of the Segal Cancer Centre. This study was supported through a post-PhD research fellowship of the Canadian Cancer Society/National Cancer Institute of Canada to Dr. MTE Puts. The study was sponsored Solidage McGill University/Université de Montreal Research Group on Frailty and Aging and the McGill Dr. Joseph Kaufman Chair in Geriatric Medicine.

Conflict of interest

There was no conflict of interest.

Disclosures

None.

References

  1. 1.
    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 27:2758–2765CrossRefPubMedGoogle Scholar
  2. 2.
    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 281:552–557CrossRefGoogle Scholar
  3. 3.
    Amalraj S, Starkweather C, Nguyen C, Naeim A (2009) Health literacy, communication, and treatment decision-making in older cancer patients. Oncology (Williston Park) 23:369–375Google Scholar
  4. 4.
    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 22:982–987CrossRefPubMedGoogle Scholar
  5. 5.
    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 194:8–13CrossRefPubMedGoogle Scholar
  6. 6.
    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 58:2325–2336CrossRefPubMedGoogle Scholar
  7. 7.
    Huijer M, van Leeuwen E (2000) Personal values and cancer treatment refusal. J Med Ethics 26:358–362CrossRefPubMedGoogle Scholar
  8. 8.
    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–s106PubMedGoogle Scholar
  9. 9.
    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 5:117–122CrossRefPubMedGoogle Scholar
  10. 10.
    Montbriand MJ (1998) Abandoning biomedicine for alternate therapies: oncology patients' stories. Cancer Nurs 21:36–45CrossRefPubMedGoogle Scholar
  11. 11.
    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):636–646CrossRefPubMedGoogle Scholar
  12. 12.
    Sinding C, Wiernikowski J, Aronson J (2005) Cancer care from the perspectives of older women. Oncol Nurs Forum 32(1538–0688; 6):1169–1175CrossRefPubMedGoogle Scholar
  13. 13.
    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 CrossRefPubMedGoogle Scholar
  14. 14.
    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 04-5496Google Scholar
  15. 15.
    Carbone PP, Kaplan HS, Musshoff K, Smithers DW, Tubiana M (1971) Report of the committee on Hodgkin's disease staging classification. Cancer Res 31:1860–1861PubMedGoogle Scholar
  16. 16.
    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 36:842–854CrossRefPubMedGoogle Scholar
  17. 17.
    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 12:189–198CrossRefPubMedGoogle Scholar
  18. 18.
    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 53:695–699CrossRefPubMedGoogle Scholar
  19. 19.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370CrossRefPubMedGoogle Scholar
  20. 20.
    Fillenbaum GG, Smyer MA (1981) The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. J Gerontol 36:428–434PubMedGoogle Scholar
  21. 21.
    Katz S (1983) Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 31:721–727PubMedGoogle Scholar
  22. 22.
    Groll DL, To T, Bombardier C, Wright JG (2005) The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol 58:595–602CrossRefPubMedGoogle Scholar
  23. 23.
    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 5:649–655CrossRefPubMedGoogle Scholar
  24. 24.
    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 21:3214–3219CrossRefPubMedGoogle Scholar
  25. 25.
    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 115:1185–1193CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Martine T. E. Puts
    • 1
    • 2
    • 3
  • Johanne Monette
    • 1
    • 4
    • 7
  • Veronique Girre
    • 1
    • 5
  • Christina Wolfson
    • 2
    • 6
  • Michèle Monette
    • 1
  • Gerald Batist
    • 7
  • Howard Bergman
    • 1
    • 7
    • 8
  1. 1.McGill University-Université de Montréal Solidage Research Group on Frailty and AgingJewish General Hospital, McGill UniversityMontrealCanada
  2. 2.Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealCanada
  3. 3.Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoCanada
  4. 4.Division of Geriatric MedicineJewish General Hospital, McGill UniversityMontrealCanada
  5. 5.Institut Curie, Department of Medical OncologyParisFrance
  6. 6.Division of Clinical EpidemiologyMcGill University Health Centre, McGill UniversityMontrealCanada
  7. 7.Department of Oncology, Segal Cancer CentreJewish General Hospital, McGill University MontrealMontrealCanada
  8. 8.Solidage Research Group on Frailty and Aging, Centre for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical ResearchJewish General Hospital, McGill UniversityMontrealCanada

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