Grant: Project Grant

Cancer is a significant problem, affecting 206,200 Canadians every year and surpassing cardiovascular disease as the top cause of death. While there are dietary, environmental, and familial risk factors for cancer, advanced age is in fact the most frequent risk factor, with most cancers occurring over the age of 65 years. In the geriatric population, there are consistent data to indicate that older patients are undertreated for their cancer when compared to their younger counterparts. Studies uniformly indicate that undertreatment results in worse outcomes, including increased morbidity and shortened survival. Older cancer patients without significant illnesses and who are otherwise able to tolerate treatment, but 1) who are not referred to a cancer specialist, 2) who do not initiate cancer treatment, or 3) who do not complete a full course of treatment potentially represent cases of undertreatment. While there are many reasons for undertreatment, there is a lack of studies on the role of physicians in the cancer treatment decision-making process, particularly in the context of the older cancer population. Likewise, there is minimal evidence on how physician factors interact with patient and disease factors in contributing to undertreatment. Studying physician factors has been largely neglected even though physicians have a significant direct and indirect influence on treatment decisions. The main purpose of the proposed study is to advance cancer care in the older cancer population by evaluating physician factors and how they interact with patient and disease factors in the cancer treatment decision making process. By fully understanding the physician's role and the patients' expectations of their physicians, we can design and implement better and more feasible strategies to reduce undertreatment of older cancer patients. This study will produce a list of candidate interventions aimed at minimizing age-related treatment biases to improve outcomes for patients.