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Patient Age, Well-Being, Perspectives, and Care Practices in the Early Treatment Phase for Late-Stage Cancer

¹ Case Western Reserve University School of Medicine, Cleveland, Ohio.
² MetroHealth Medical Center, Cleveland, Ohio.
³ Louis Stokes Cleveland VAMC-GRECC, Ohio.
⁴ Case Comprehensive Cancer Center Program on Aging-Cancer Research, Cleveland, Ohio.

Address correspondence to Julia Hannum Rose, PhD, MA, Department of Medicine–Geriatrics and Palliative Care, Case Western Reserve University, 2500 MetroHealth Drive R245A, Cleveland, Ohio 44109. E-mail: julia.rose{at}case.edu

Background. Among advanced-stage cancer patients, age is an important determinant of decision making about medical care. We examined age-related differences in patient well-being, care perspectives, and preferences, and the relationship between these patient characteristics and subsequent care practices including care communication, pain management, and acute care utilization during the early treatment phase of late-stage cancer.

Methods. Patient demographics, well-being, and care perspectives were assessed during patient and physician baseline interviews. Care practices were measured using outpatient and inpatient records for the 30-day period after baseline assessment. Multivariate regression models were used to examine the patterns of association of age and other patient characteristics with care practices.

Results. A total of 174 middle-aged and 149 older patients with recently diagnosed late-stage cancer were included. Older patients had more comorbidities but lower levels of depression, anxiety, and symptom distress. Older patients preferred pain relief/comfort as a treatment goal, but received fewer prescriptions for opioids. Whereas provider-initiated communication with patients/families was positively associated with severity of illness, patient/family-initiated communication was associated with patient psychosocial attributes and care perspectives. Satisfaction with care was inversely associated with reports of pain. Symptom distress was positively associated with subsequent opioid prescriptions and hospitalizations.

Conclusions. Our results help to explain the role of patients' psychosocial attributes, care perspectives, and preferences in subsequent care practices during the early treatment phase for late-stage cancer. Age-related differences in patient well-being and care perspectives suggest a role for age-sensitive interventions in the treatment of advanced cancer patients.

Key Words: Late-stage cancer • Age • Well-being • Care practices

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