Originally published as JCO Early Release 10.1200/JCO.2003.08.091 on July 21 2003

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Are Older French Patients As Willing As Older American Patients to Undertake Chemotherapy?

From the H. Lee Moffitt Cancer Center and Research Institute and the University of South Florida, Tampa, FL; the Lyon University, Centre Léon-Bérard, and Hôpital Antoine Charial, Lyon, France; and the Centre de Soins Continus (Cesco), University of Geneva, Switzerland.

Address reprint requests to Martine Extermann, MD, Senior Adult Oncology Program; Moffitt Cancer Center; 12902 Magnolia Dr, Tampa, FL 33612; e-mail: extermann{at}moffitt.usf.edu.

Purpose: A view often held in Europe is that older Europeans are less willing than older Americans to undertake chemotherapy. This study assesses whether this view is valid.

Patients and Methods: Three-hundred twenty outpatients aged 70 years and older were interviewed via anonymous questionnaires: French patients with and without cancer and American patients with and without cancer. The response rate was 61% (195 of 320 questionnaires). Ages ranged from 70 to 95 years (29% aged 80 years and older). Two scenarios were presented: a strong chemotherapy (platinum/taxane combination–like) and a milder chemotherapy (weekly vinorelbine–like). The options were to refuse chemotherapy or to accept for a threshold chance of cure, of life prolongation, or of symptom relief. Functional status, education, self-rated health, and depression were controlled for.

Results: French noncancer patients (34%) were less willing to accept the strong chemotherapy than French cancer patients (77.8%), American noncancer patients (73.8%), and American cancer patients (70.5%) (P < .001 for each pair). This was also true for the moderate chemotherapy (67.9% v 100%, 95.2%, and 88.5%, respectively; P < .001). Age and sex did not correlate with response, but self-rated health, cancer status, and nationality did. Thresholds varied from patient to patient.

Conclusion: Whereas older French people without cancer are more reluctant than older Americans to envision chemotherapy, older cancer patients in both countries have the same amenability to treatment. Chemotherapy options should be fully discussed with older cancer patients, given that most are willing to consider them.

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