Important aspects of care and priorities of older patients with cancer: The PRIORITY multicenter cohort study.

[INTRODUCTION] Data on treatment preferences in older cancer patients are lacking. We aimed to identify their priorities.

[MATERIALS AND METHODS] We conducted a multicenter prospective cohort study on patients with cancer aged ≥70 and 18-69, initiating first medical treatment. Patients and physicians prioritized eight aspects of care: treatment efficacy, life expectancy, autonomy, daily tasks, social activities, treatment burden, toxicity, and economic burden via self-completed questionnaires. The primary endpoint was the priorities of older patients.

[RESULTS] We included 233 older and 100 younger patients at eight sites. In the older patient cohort, median age was 79 (min-max: 70-97), breast cancer represented 34 % (N = 78) and lung 12 % (N = 27). Metastatic setting concerned 45 % of the patients. The most frequently rated top priority at treatment initiation was treatment efficacy in both older (73 %) and younger cohorts (79 %), followed by autonomy in the older cohort (13 %) and life expectancy in the younger cohort (14 %). Treatment efficacy was almost systematically cited in the top four priorities for both older (94 %) and younger patients (96 %), followed by autonomy (86 %) for older and life expectancy (82 %) for younger patients. These priorities were stable (>70 %) between initiation and three months for each cohort. Agreement rate for prioritization of aspects of care between older patients and physicians was 87 % for treatment efficacy and 64 % for autonomy.

[DISCUSSION] Autonomy was the second most cited priority among older patients, yet many physicians failed to recognize this, potentially affecting treatment decisions. These findings highlight the need for shared decision-making to align treatment choices with patient expectations.