Yellen S B, Cella D F, Leslie W T
Department of Psychology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612.
J Natl Cancer Inst. 1994 Dec 7;86(23):1766-70. doi: 10.1093/jnci/86.23.1766.
Ageism is a cultural bias that might inappropriately steer oncologists away from recommending aggressive treatments for older patients. The extent to which older patients might prefer less aggressive cancer therapies is unknown. Our lack of knowledge about patients' personal preferences for therapy may perpetuate this bias.
We conducted a study to determine 1) if age influences patient acceptance of cancer therapy and 2) if the older patients would be more or less likely to trade increased survival for maintaining quality of life than their younger counterparts.
Using an interview format, 244 cancer patients of all ages treated at a tertiary care cancer center read two sets of hypothetical vignettes. The first set consisted of four vignettes that varied in terms of stage of disease and treatment toxicity. Patients were asked to make hypothetical decisions about treatment given with respect to varying levels of either increasing cure or extending survival. The second set of vignettes presumed acceptance of cancer therapy. Within each vignette, two hypothetical treatments (mild versus severe) with different probabilities of 1-year survival were contrasted. The point at which patients shifted preferences from a treatment with mild versus severe side effects was the dependent measure. Mixed analysis of variance (ANOVA) procedures (F test) assessed the impact of age (< 65 years versus > or = 65 years) and patient disease stage (early versus advanced) on hypothetical decisions about treatment. All P values are two sided.
In the treatment-preference vignettes, there was no effect of either age [F(1,239) = 2.14; P = .14] or patient stage [F(1,239) = .40; P = .53] on treatment acceptance. Older adults were as likely as their younger counterparts to agree to chemotherapy for both curative and control purposes. In the switch-point vignettes, younger adults switched to a more toxic treatment to gain survival advantage at an earlier point than the older patients in both the early-disease vignette [F(1,232) = 3.88; P = .05] and the advanced-disease vignette [F(1,232) = 4.43; P = .036]. There was neither an effect of disease stage on treatment decisions nor an interaction between disease stage and age.
In a tertiary care setting, older adults do not differ from their younger counterparts in terms of acceptance of chemotherapy. However, when treatment is presumed, they differ in terms of willingness to trade survival for current quality of life. Generalization of findings is limited by the relatively small sample of older adults (n = 43) and the referral population from which the sample was drawn. Replication with a larger older adult sample in a community setting is needed.
年龄歧视是一种文化偏见，可能会不适当地使肿瘤学家不倾向于为老年患者推荐积极的治疗方法。老年患者对不那么积极的癌症治疗的偏好程度尚不清楚。我们对患者个人治疗偏好的了解不足可能会使这种偏见长期存在。
我们进行了一项研究，以确定1）年龄是否会影响患者对癌症治疗的接受程度，以及2）与年轻患者相比，老年患者是否更愿意或更不愿意用提高生存率来换取生活质量的维持。
采用访谈形式，让在一家三级医疗癌症中心接受治疗的244名各年龄段癌症患者阅读两组假设性的病例描述。第一组由四个病例描述组成，这些病例描述在疾病阶段和治疗毒性方面有所不同。患者被要求就针对不同程度的提高治愈率或延长生存期的治疗做出假设性决定。第二组病例描述假定患者接受癌症治疗。在每个病例描述中，对比了两种具有不同1年生存率概率的假设性治疗（轻度与重度）。患者从轻度副作用治疗转向重度副作用治疗的偏好转变点是因变量。方差混合分析（ANOVA）程序（F检验）评估年龄（<65岁与≥65岁）和患者疾病阶段（早期与晚期）对治疗假设性决定的影响。所有P值均为双侧。
在治疗偏好病例描述中，年龄[F(1,239)=2.14；P = 0.14]或患者阶段[F(1,239)=0.40；P = 0.53]对治疗接受度均无影响。老年人与年轻患者一样，愿意为治愈和控制目的接受化疗。在转换点病例描述中，在早期疾病病例描述[F(1,232)=3.88；P = 0.05]和晚期疾病病例描述[F(1,232)=4.43；P = 0.036]中，年轻成年人比老年患者更早转向毒性更大的治疗以获得生存优势。疾病阶段对治疗决定没有影响，疾病阶段与年龄之间也没有相互作用。
在三级医疗环境中，老年人在接受化疗方面与年轻患者没有差异。然而，在假定接受治疗的情况下，他们在为当前生活质量而牺牲生存率的意愿方面存在差异。研究结果的推广受到老年成年人样本相对较小（n = 43）以及抽样所来自的转诊人群的限制。需要在社区环境中用更大的老年成年人样本进行重复研究。
