Multidisciplinary decision-making in older patients with cancer: balancing benefit, harm, and patient priorities

Tailoring care for older patients with cancer

Cancer is a disease of older age. Older cancer patients have an increased risk of negative treatment outcomes, such as treatment side effects, complications and functional decline. There are, however, large differences between older patients regarding their vitality and values. Therefore older patients are at risk of overtreatment (too intensive treatment resulting in unwanted outcomes) and undertreatment (refraining from treatment based on age alone). Both of these are unwanted.
We investigated a new care trajectory for older patients with cancer. In this care trajectory we do not only consider the aspects of the disease, but we also focus on the individual patient: who is this patients and what are his goals and preferences. Nurses have an important role in gathering this patient-specific information. Both the disease-specific and patient-specific information are then considered and weighed in a multidisciplinary team meeting and a tailored treatment proposal is formulated.
By incorporating patient-specific information in the decision making process, the treatment plan was altered in a quarter of patients. This was mostly towards a less intensive treatment regime. This less intensive treatment did not result in higher mortality, and patients spent less days in the hospital and had a lower rate of complications. These are promising results. In future studies we want to increase our knowledge on how this new care trajectory influences the outcomes that matter most to the patients and how we can better predict these outcomes.