The effect of age on the opportunity to receive cancer treatment

Steven Habbous; Shabbir M H Alibhai; Ines B Menjak; Katharina Forster; Claire M B Holloway; Gail Darling

doi:10.1016/j.canep.2022.102271

The effect of age on the opportunity to receive cancer treatment

Cancer Epidemiol. 2022 Dec:81:102271. doi: 10.1016/j.canep.2022.102271. Epub 2022 Oct 6.

Authors

Steven Habbous¹, Shabbir M H Alibhai², Ines B Menjak³, Katharina Forster⁴, Claire M B Holloway⁵, Gail Darling⁶

Affiliations

¹ Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, Ontario, Canada; Epidemiology & Biostatistics, Western University, London, Ontario, Canada. Electronic address: steven.habbous@ontariohealth.ca.
² Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
³ Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁴ Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, Ontario, Canada.
⁵ Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁶ Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada.

PMID: 36209661
DOI: 10.1016/j.canep.2022.102271

Abstract

Introduction: Older adults with cancer may not receive the same opportunities for treatment as younger patients. In this retrospective population-based cohort study, we explored whether age was an independent predictor of receiving specialist consultation and treatment.

Methods: Patients age 45-99 were identified from the Ontario Cancer Registry having a primary solid tumor diagnosed between 01/Jan/2010 and 31/Dec/2019. We used logistic regression adjusted sociodemographic and clinical characteristics to compare the likelihood of consultation or receipt of treatment using linear splines at critical ages of 65, 80, and 90 years.

Results: A total 168,232 (42%), 165,205 (41%), 57,360 (14%), and 7810 (2%) patients were diagnosed age 45-64, 65-79, 80-89, and 90-99, respectively. The likelihood of surgical consultation decreased as patients reached 65 years [adjusted odds ratio (aOR) 0.86 (0.84-0.89)], which decreased further among octogenarians [aOR 0.63 (0.59-0.67)]. Similar results were observed for consultation with a medical oncologist and radiation oncologist. Receipt of surgery also decreased with age. Three-month post-operative mortality was higher among older patients [aRR 1.38 (1.26-1.50) per 10 years, p < 0.0001], an effect that remained similar as patients reached age 65 + years of age (p = 0.09 for change). For stage I patients, 3-month post-operative survival was high across all age groups, ranging from 99.8% in 45-64 year-olds, 99.4% in 65-79 year-olds, and 98.1% among octogenarians and nonagenarians (lung, colorectal, breast, cervical cancer patients).

Conclusion: Older patients were less likely to have specialist consultations. More comprehensive data collection on clinical factors and referral patterns is needed to improve care for elderly cancer patients.

Keywords: Cancer; Consultation; Elderly; Nonagenarian; Octogenarian; Treatment.