WHAT CRITERIA INFLUENCE TREATMENT DECISION-MAKING IN ELDERLY COLORECTAL CANCER PATIENTS?

OBJECTIVES: Evidence-based treatment in older colorectal cancer (CRC) patients is difficult, because of under-representation of older patients in clinical cancer trials. Explicitly considering current physical and cognitive functioning in treatment decision-making and determining trade-offs between aspects of the value framework by the ASCO Value in Cancer Care Task Force (clinical benefit, toxicity, cost) relative to other relevant criteria in elderly patients can assist clinicians in making decisions in this heterogeneous patient group. The aim of this study was to use a rigorous approach to determine the relevant decision criteria in older CRC patients, prior to conducting a stated preference (SP) study. METHODS: In a systematic literature review on decision-making criteria for the treatment decision in elderly CRC patients, 201 manuscripts were selected. Results were quantified and used as input for 11 interviews with oncologists, surgeons, radiotherapists, gastroenterologists, a radiologist, a geriatrician and an oncology nurse. The face-to-face interviews contained both structured (importance of literature study results on Likert scales) and semi-structured (missing criteria) questions. The interviews were transcribed, coded, counted and compared with the results of the systematic literature review. RESULTS: Most reported criteria both in the literature and interviews were functional status, comorbidities, age, patient preferences and expected treatment toxicity and outcomes. Other criteria were differently reported in the literature and interviews; the costs of treatment were often mentioned in the literature but not important to physicians in their treatment decision. CONCLUSIONS: The process of criteria selection in SP studies is often poorly described in the literature, although it is fundamental and critical in designing SP studies. In this study, in-depth and transparent analysis of relevant criteria in the treatment decision for older CRC patients was realized by combining both quantitative and qualitative information. This enables performing SP studies with more reliable and clinical relevant results.