Short summary

Less is known about cancer patients' attitude towards chemotherapy, especially among older patients. This questionnaire-based study is aiming to:

• Investigate disparities in the attitude towards chemotherapy among younger (<70 years) and older (70 years or more) patients with gastrointestinal cancer
• Explore if patients' attitude towards chemotherapy change during therapy - related to efficacy of their treatment
• Evaluate if the patients are aware of the indication of their treatment with chemotherapy

Rationale

When informing patients about treatment, the personal values of the health professionals may influence the decision on treatment. Studies have shown that cancer patients are much more likely to accept therapy with only a small chance of benefit than people who do not have cancer, including medical and nursing professionals (Slevin et al. 1990, Bremnes et al. 1995). However, knowledge on especially older cancer patients' attitude to treatment is lacking.

Furthermore it is found, that patients with metastatic solid cancer overestimate their life expectancy. A patient survey, performed by professional interviewers, revealed that 81% of patients with metastatic colorectal cancer (mCRC) did not realize that chemotherapy was very unlikely to cure their cancer (Weeks et al, 2012).

If the healthcare professionals should be able to give thorough and accurate information as well as guide and involve the patient in shared decisions, it is important that the healthcare professionals have an understanding about patients' attitude to chemotherapy.

The questionnaire used for this study is based on similar questionnaires developed in the 1990's describing two hypothetic treatment scenarios with different toxic side effects, practical constraints, and inconveniences (Slevin et al. 1990, Bremnes et al. 1995, Extermann et al. 2003) We have made an updated version of the two scenarios to be consistent to the practical issues, toxicity, and administration related to the most used chemotherapy in gastrointestinal cancer (5-FU and oxaliplatin) in our clinical practice.

To evaluate if the patients are aware of the indication of their treatment with chemotherapy, the patients are to answer if their treatment is given with the intent of curation, life-sustaining, or symptom management. A review of the patients' hospital record will be performed to clarify the indication of the treatment and compared to the view of the patient.

In the follow-up questionnaire handed out after 2 months of treatment, the two hypothetic scenarios are repeated and the patient is asked about toxicities to their treatment and if the treatment was worth the effort.

Description of the cohort

All patients with gastrointestinal cancer (esophageal, stomach, pancreatic, gallbladder, GIST tumors, colon and rectal cancer) referred to palliative chemotherapy at the out-patient clinic at Department of Oncology, Odense University Hospital, Denmark. The patients must not have received any prior chemotherapy.

Data and biological material

Patients are to fill in two questionnaires during the study:

• Questionnaire 1 is filled out before the first evaluation at the out-patient clinic at Department of Oncology, Odense University Hospital. It contains a description of two hypothetic treatment scenarios with different grade of toxicity to which questions regarding prolonging of life expectancy and symptom relief are to be answered. Additionally patients are to answer if their treatment is given with the intent of curation, life-sustaining, or symptom management.
• Questionnaire 2 is filled out after 2 months of treatment, but before evaluation of efficacy of the treatment. The two hypothetic treatment scenarios described above are repeated, the patients are asked about potential toxicities to their own treatment and if the treatment was worth the effort.

It is possible to fill in both questionnaires online or in a printed version.

A review of the patients' hospital record will be performed to clarify the indication of the treatment and compared it to the view of the patient.

Collaborating researchers and departments

Department of Oncology, Odense University Hospital

• Professor Per Pfeiffer, MD, PhD 
• Camilla Qvortrup, MD, PhD

Department of Geriatric Medicine, Odense University Hospital

• Jesper Ryg, MD, PhD

Department of Rehabilitation, Odense University Hospital

• Physiotherapist Eva Jespersen, PhD 

The study is a part of AGECARE - Academy of Geriatric Cancer Research.