Healthcare provider bias in cancer treatment decisions for elderly patients

The global population of elderly people is increasing, even in Japan. As a result, the number of elderly people requiring cancer treatment is also increasing, and it is necessary to assess the tolerability of elderly people. In recent years, the Comprehensive Geriatric Assessment (CGA), an objective assessment tool for evaluating elderly patients, has been introduced, but it is not yet common. In this study, we compared elderly cancer patients who were divided into standard treatment and non-standard treatment groups due to the subjective bias of healthcare providers and examined what was being subjectively selected without being conscious of it.

We retrospectively reviewed cases of patients aged 75 and older diagnosed with endometrial cancer, cervical cancer, or ovarian cancer at our hospital between April 1, 2018, and March 31, 2022, who surgery was deemed the standard treatment. Data on age, body mass index (BMI), performance status (PS), pre-treatment blood hemoglobin (Hb), albumin (Alb), creatinine (Cre), cancer antigen 125 (CA 125) levels, use of oral medications (antihypertensives, diabetes medications, anticoagulants, antiplatelet agents, diuretics), and history of malignancies were collected from electronic medical records. Patients who underwent standard treatment (standard treatment group) were compared to those who had changes in surgical content or received non-surgical treatments (non-standard treatment group).

In standard treatment group, age, nutritional status (body mass index, albumin and hemoglobin levels) and physical functions (performance status) were significantly higher, which are the main evaluation factors of CGA.

These results suggest that the bias of healthcare providers to some extent reflects the CGA.