Impact of Age on Physician's Decision to Pursue Active Treatment in Elderly Patients with Myelodysplastic Syndromes: Results from an Internet-Based Survey

Myelodysplastic syndromes (MDS) are a group of hematological disorders predominantly affecting older patients. A patient's age influences the treating physician's decision to proceed with active treatment in MDS, with older patients being less likely than younger patients to receive active treatment, irrespective of their physical status.

This study is an internet-based survey of hematologists and oncologists who treat patients with MDS consisting of a 47-item questionnaire designed to assess 1) factors physicians consider when determining treatment recommendations for MDS patients, 2) the impact of patient age on treatment decisions and 3) views on tools available to physicians to guide their treatment plans. Respondents were given hypothetical patient scenarios and asked to select their recommended treatment based on the available information.

A total of 310 online interviews were conducted in North America and Europe. Although physicians cited biological age and disease performance status as more important, chronological age nevertheless emerged as a strong influencing factor on their treatment recommendations for MDS patients aged 65 years and older. For instance, physicians were significantly more likely to prescribe active therapy to a 70-year-old patient with secondary MDS and an intermediate International Prognostic Scoring System level than to an 80-year-old patient with otherwise identical characteristics (32% vs. 12%; p<0.05). Concerns regarding treatment toxicity influenced the recommendations of 66% of physicians, and 29% expressed dissatisfaction with the amount of data available to help guide treatment recommendations. A majority (62%) agreed that better guidelines would prevent under-treatment of older patients.

Chronological age can influence physicians' treatment recommendations for MDS patients. The findings suggest that some older patients may be denied appropriate treatment options due to age and support the need for additional clinical evidence for older patients with MDS, such as validated comprehensive geriatric assessment tools to support treatment decisions regarding active treatment.

Smith:Celgene: Honoraria. Santini:Celgene: Honoraria. Kurtin:Celgene: Honoraria. Huber:Celgene: Honoraria. Campbell:Celgene: Honoraria. Waldman:Celgene: Honoraria.