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S30
A B S T R A C T S
O12
CHOOSING TO TRUST: CANCER TREATMENT DECISION
MAKING FROM THE PERSPECTIVE OF OLDER ADULTS WITH
COLORECTAL CANCER
F. J. Strohschein
1,2,3,
*, H. Bergman
4
, R. S. Schreiber
5
,
C. G. Loiselle
2,3
1
Department of Geriatrics,
2
Segal Cancer Centre, Jewish General
Hospital,
3
Ingram School of Nursing,
4
Department of Family
Medicine, McGill University, Montreal,
5
School of Nursing,
University of Victoria, Victoria, Canada
Introduction:
In Canada, 53% of new colorectal cancer
(CRC) cases and 66% of CRC deaths occur in people 70 years
and older, a situation mirrored across North America and
Europe. Treatment decision making (TDM) is a significant
part of the CRC trajectory, presenting patients with a choice
of treatments, or the option to accept or refuse a single
recommendation. For older adults, variations in health and
functional status, along with exclusion from clinical trials,
changes in support networks, and increased tension between
quality and quantity of life, present important dilemmas for
TDM. Although authors advocate for patient engagement in
TDM, little is known about the process from the perspective
of older adults with CRC.
Objectives:
To gain in-depth understanding of TDM from
the perspective of people, aged 70 years or older, with an
initial pathological or clinical diagnosis suggesting primary
cancer of the colon or rectum, receiving care at a university-
affiliated hospital cancer centre in Montreal, Canada.
Methods:
This prospective, longitudinal qualitative
study is informed by grounded theory methodology. 18
participants (10 men, 8 women), aged 71 to 88 (median=81)
years, were purposively sampled and followed through
their initial treatment trajectories of 3.2 to 17.5 (median =
7.1) months. Interviews were conducted before treatment
began and after initial treatment was completed. Between
interviews, participants recorded thoughts and experiences
in a written or audio diary and/or through brief phone
calls/visits with the researcher. 281 audio-recorded
interactions and 234 diary entries were documented and
excerpts transcribed verbatim. Demographic and medical
information was collected. Data collection and analysis
were concurrent, guided by constant comparison. Member-
checking provided additional insight and NVivo10 software
facilitated the analytic process.
Results:
When faced with CRC, participants were shocked
by the diagnosis and felt turned inside out by the symptoms,
side effects, and complications of disease and treatment.
Many interpreted these threats in relation to bodily changes
associated with aging, while contemplating the number of
yearsleft,andholdingontohopebecameanimportantconcern.
Choosing to trust was the primary way they held onto hope,
aligning themselves with the health care system to receive
medical care and treatment. After describing a clear decision
point to step into the healthcare system and proceed towards
treatment, participants experienced a strong momentum
propelling them to and through medical treatment. As long
as they were able to manage the momentum, they continued
to trust the team and remain engaged in care. When they felt
unable to manage the demands, trust was broken and they
hesitated or stepped out of the momentum.
Conclusion:
Trust plays a central role in TDM among older
adults with CRC. The substantive theory constructed herein
informs identification of personal, systemic, and socio-
political factors shaping trust, and thus TDM. Interventions
are needed to support the work older patients do to situate
their diagnosis, proposed treatment, and current health status.
Multidisciplinary collaboration is key, informing appropriate
treatment recommendations and supporting older patients’
ability to manage the treatment-related momentum. With
further corroboration, study findings may be used to inform
personalized care and illness management and mobilize
appropriate health resources for older adults with cancer and
their families.
Disclosure of interest:
None declared
Keywords:
Aged, colorectal cancers, patient acceptance of
healthcare, treatment decision making
O13
LONG TERM OUTCOME IN ELDERLY SURGICAL CANCER
PATIENTS
S. Stokmans
1,
*, E. Rotteveel
1
,
H. van der Wal - Huisman
1
, G. de Bock
2
, A. Absalom
3
,
B. van Leeuwen
1
and PICNIC study group
1
Surgical Oncology,
2
Epidemiology,
3
Anesthesiology, University
Medical Center Groningen, Groningen, Netherlands
Introduction:
The majority of cancer patients are over 64
years of age and most of them are in need of surgery. High
occurrence of morbidity and mortality are of major concern
in this onco-geriatric population. Therefore there is an urgent
need for factors predicting these adverse events to facilitate
the surgical decision-making process. It is known that
certain frailty indicators can predict short term morbidity
and mortality; however, predictors of long-term mortality are
unclear.
Objectives:
To identify
if known frailty indicators (being
the handgrip strength test (HGS), timed up and go test (TUG)
and Groningen frailty indicator (GFI)) can predict morbidity
and long-term mortality among elderly patients undergoing
surgery for solid malignancies.
Methods:
This is a large single-center prospective
observational cohort study including patients of 65 years and
older undergoing a surgical procedure for a solid malignant
tumor.
The timed up and go test (TUG), handgrip strength
test (HGS) and Groningen Frailty Indicator (GFI) were
performed preoperative, 2 weeks postoperative and 3 months
postoperative. Primary endpoints were 30-day morbidity and
1 year mortality.
Results:
There were 254 patients evaluated between
September 2010 and May 2015. Mean duration of follow up
was 38.5 months (range 12-68 months). Mean age was 72
years, 52.8% were male and the majority was treated for
colorectal carcinoma (29.5%), and malignancies of skin
(13%) and soft tissue (11%). Sixty-three percent of patients