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New Study is Strongest Proof that Age, not Life Expectancy, is Main Factor in Deciding Treatment
Toronto (Dec. 15, 2003) - When it comes to deciding what kind of treatment a man with prostate cancer receives, the person's age trumps life expectancy, according to a new study from the University Health Network.
The findings, to be published in the January edition of the journal Cancer, run counter to the accepted medical practice of deciding treatment options based on the length of remaining time a patient is expected to live, rather than his age. The study examined the charts and records of 347 randomly chosen prostate cancer patients from across Ontario, and showed that older men who are healthier and expected to live for at least another 10 years are more likely to receive inadequate cancer treatment than a younger prostate cancer patients who will probably die sooner.
"These are worrisome findings that suggests older prostate cancer patients may face a bias because of age," said Dr. Shabbir Alibhai, lead author of the study, a physician with University Health Network, and Assistant Professor with the University of Toronto's Departments of Medicine & Health Policy, Management, and Evaluation. "Even though an older prostate cancer patient's prognosis may be better than a younger patient's, they likely won't receive important treatment that could significantly extend their life."
Even after adjusting for the remaining life expectancy of a patient, researchers found that a prostate cancer patient younger than 60 years old was 25 times more likely to be treated with curative surgery than a man 70 years or older - even if both were expected to have the same number of years left to live.
A study published earlier this year by Dr. Alibhai showed that healthy older men, particular those in their 70s, who have aggressive prostate cancer benefit significantly from surgery or radiation therapy. With appropriate treatment these patients can receive an extra year of life or more, with most having an improved quality of life as well, the earlier study showed.
"This new study is important because it is the strongest data so far to show that many treating doctors are not sensitive to the issue of age," said Dr. Neil Fleshner, a urologist and head of Princess Margaret Hospital's Genitourinary site group. "Life expectancy, not age, should be the main factor in determining which prostate cancer patients receive appropriate treatment."
The research was supported in part by the Department of Medicine, University of Toronto; the Physicians Services Incorporated Foundation; the Toronto Rehab Foundation; the Canadian Institutes for Health Research; and the Mary Trimmer Chair in Geriatric Medicine Research, University of Toronto.
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