Decision Making in Older Adults With Cancer
Authors: Clark DuMontier, Kah Poh Loh, Enrique Soto-Perez-de-Celis, William Dale
Journal: Journal of Clinical Oncology (2021)

Article Tools REVIEW ARTICLES Caring for Older Adults With Cancer Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.21.00165 Journal of Clinical Oncology - published online before print May 27, 2021 PMID: 34043434 Decision Making in Older Adults With Cancer Clark DuMontier , MD, MPH1,2xClark DuMontierSearch for articles by this author; Kah Poh Loh , MBBCh, BAO3xKah Poh LohSearch for articles by this author; Enrique Soto-Perez-de-Celis , MD4xEnrique Soto-Perez-de-CelisSearch for articles by this author; and William Dale , MD, PhD5xWilliam DaleSearch for articles by this author Show More 1Brigham and Women's Hospital, Boston, MA2Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA3James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY4Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico5City of Hope Comprehensive Cancer Center, Duarte, CA https://doi.org/10.1200/JCO.21.00165 First Page Full Text PDF Figures and Tables Supplements © 2021 by American Society of Clinical OncologyCONTEXTKey ObjectiveThis conceptual review on medical decision making in older adults with cancer synthesizes the evidence, identifies key knowledge gaps, and provides a decision framework that incorporates current best practices.Knowledge GeneratedAlthough the evidence base in geriatric oncology is expanding, oncologists must continue to make treatment decisions under considerable uncertainty. Our decision framework helps optimize decision making on the basis of three principles: (1) determining age-related vulnerability using the geriatric assessment, (2) considering the overall benefits and harms of cancer treatments for older adults in light of this vulnerability, and (3) incorporating patient values and preferences.RelevanceUsing this framework matches treatment intensity with age-related vulnerability and aligns expected outcomes with preferences, thus minimizing undertreatment and overtreatment in older adults with cancer. This framework can be adapted to all cancer types and treatment modalities and will strengthen as the evidence in geriatric oncology continues to grow.SUPPORTSupported by the Harvard Translational Research in Aging Training Program (National Institute on Aging of the National Institutes of Health: T32AG023480) (C.D.); the Wilmot Research Fellowship and National Cancer Institute (K99 CA237744) (K.P.L.); the Conquer Cancer (The ASCO Foundation) Career Development Award and the National System of Researchers of Mexico (E.S.); Geriatric Oncology Research Infrastructure to Improve Clinical Care (NIA R33AG059206) and Mentoring the Next Generation of Geriatric Oncology Researchers in Patient-Oriented Research to Improve the Care of Older Adults With Cancer (NIA K24AG055693) (W.D.).AUTHOR CONTRIBUTIONSConception and design: Clark DuMontier, Kah Poh Loh, Enrique Soto-Perez-de-Celis, William DaleAdministrative support: Clark DuMontier, William DaleFinancial support: Clark DuMontier, William DaleProvision of study materials or patients: Clark DuMontier, Kah Poh Loh, Enrique Soto-Perez-de-CelisCollection and assembly of data: Clark DuMontier, Kah Poh Loh, Enrique Soto-Perez-de-CelisData analysis and interpretation: Clark DuMontier, Kah Poh Loh, Enrique Soto-Perez-de-Celis, William DaleManuscript writing: All authorsFinal approval of manuscript: All authorsAccountable for all aspects of the work: All authorsAUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTERESTDecision Making in Older Adults With CancerThe following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).Kah Poh LohConsulting or Advisory Role: Pfizer, Seattle GeneticsEnrique Soto-Perez-de-CelisResearch Funding: RocheNo other potential conflicts of interest were reported.