Effects of a time out consultation with the general practitioner on cancer treatment decision-making: a randomised controlled trial: Time out with the general practitioner and cancer treatment decision.

OBJECTIVE: Improving shared decision-making (SDM) enables more tailored cancer treatment decisions. We evaluated a Time Out consultation (TOC) with the general practitioner (GP), between cancer diagnosis and treatment decision, which aims at supporting SDM and improving continuity of primary care. This study aims to evaluate the effects of a TOC on perceived SDM, information provision and self-efficacy. METHODS: This randomised controlled trial included newly diagnosed patients with curable cancer (breast, lung, colorectal, gynaecologic and melanoma) from four Dutch hospitals. Primary outcome is perceived SDM and secondary outcomes are information provision and self-efficacy. RESULTS: One hundred fifty-four patients (control n = 77, intervention n = 77) - female: 75%, mean age: 61 (SD ± 11.9). In the intervention group, 80.5% (n = 62) had a TOC, of which 82.3% (n = 51) took place after treatment decision. Perceived SDM was lower in the intervention group (-8.9 [95% CI: 0.6-17.1]). Among those with a TOC before treatment decision (n = 11), perceived SDM was comparable to the control group (66.5 ± 27.2 vs. 67.9 ± 26.1). CONCLUSION: Even though patients are motivated to have a TOC, implementing a TOC between diagnosis and treatment decision is challenging. Effects of a timely TOC could not be established. Non-timely TOC decreased perceived SDM. Planning of the TOC should be optimised, and future research should establish if adequately timed TOC results in improved SDM in cancer patients.

Chemotherapy in the oldest old: Choices and outcomes.

Treatment decision-making in older patients with cancer is difficult due to a paucity of data evaluating chemotherapy tolerability in this population. We investigated the feasibility of chemotherapy in the oldest old and performed a singl-centre retrospective analysis of patients aged ≥80 years initiating chemotherapy for one of five common solid malignancies or non-Hodgkin lymphoma between 2010 and 2016. Treatment plan and course were extracted from medical files. Primary outcome was whether chemotherapy was completed according to plan, defined as a calculated relative dose intensity (RDI) ≥85%. A total of 104 patients receiving 129 chemotherapy lines were included. Median age at diagnosis was 82 years (range 80-94 years). Most patients (64%) received palliative intent chemotherapy. Primary and secondary chemotherapy adaptations were implemented in 63% and 65% of the cases, and hospitalisation occurred in a quarter. 52% of all cases completed chemotherapy according to plan. Almost half of the chemotherapy regimens started in the oldest old were not completed according to plan, despite frequently implemented upfront adaptations. The decision to start chemotherapy in these patients should be carefully considered. To improve decision-making in current practice, there is a need for the implementation of validated tools assessing chemotherapy feasibility in these patients.