Age-related differences in patient preferences for adjuvant chemotherapy for high-risk endometrial cancer

Introduction: Adjuvant chemotherapy in the treatment of endometrial cancer can be difficult to tolerate for older women. This study examined age-related differences in patient preferences for chemotherapy in women with high-risk endometrial cancer. Methods: We re-analyzed data from the cross-sectional patient preference study PRETEC-2 to determine the difference between three age groups in minimally desired survival benefit of chemotherapy. For this, patients with high-risk endometrial cancer treated with adjuvant pelvic radiotherapy with or without chemotherapy completed a treatment trade-off questionnaire. Patients also rated the importance they attributed to treatment duration and acute and late side-effects for their decision on chemotherapy, which we analyzed by age group. Results: A total of 171 patients (23% <60 years, 40% 60–69 years and 37% ≥70 years) were included in the analysis. Older patients had a significantly higher median minimally desired survival benefit for preferring chemoradiotherapy (5% for <60 years, 8% for 60–69 years and 15% for patients ≥70 years; (p<0.001)), and had the largest variability in minimally desired survival benefit. For a real-life five-year survival benefit of 5%, fewer older patients preferred the addition of chemotherapy to their treatment regimen (61.5% for <60 years, 45.6% for 60–69 years and 21.9% for ≥70 years; p<0.001). Furthermore, older patients rated both treatment duration (p=0.001) and long-term tingling or numbness (p=0.005) as significantly more important than their younger counterparts. Conclusion: There is more heterogeneity in the desired benefit of chemotherapy among patients aged 70 years or more compared to younger patients. This underlines the importance of recognizing individual differences and the need for shared decision-making.