• John D Parr, Baohui Zhang, Matthew E Nilsson, Alexi Wright, Tracy Balboni, Edmund Duthie, Elizabeth Paulk, and Holly G Prigerson.
• Department of Medical Education, Medical College of Wisconsin, Milwoukee, Wisconsin 53213, USA. jparr@mcw.edu
• J Palliat Med. 2010 Jun 1;13(6):719-26.

BackgroundAge differences may help to explain discrepancies in medical care received by cancer patients near death.ObjectivesUnderstanding age differences in advanced cancer patients' end-of-life experiences.DesignNCI and NIMH funded multi-site prospective cohort study.Participants396 deceased cancer patients, mean age (58.6 +/- 12.5), in the Coping with Cancer study.MeasurementsBaseline interviews (Treatment Preference) and 1 week postmortem chart reviews (Treatment Received).Results14.1% of patients were 20-44 years old, 54.0% were 45-64 years old, and 31.8% were > or = 65 years old. Compared to younger patients, middle-aged patients wanted less life-prolonging care (OR 0.32; CI 0.16-0.64). In the last week of life, older patients were less likely to undergo ventilation (OR 0.27; CI 0.07-1.00) than younger patients. Middle-aged patients who preferred life-prolonging care were less likely to receive it than younger patients (OR 0.21; CI 0.08-0.54), but were more likely to avoid unwanted life-prolonging care (OR 2.38; CI 1.20-4.75) than younger patients. Older patients were less likely to receive desired life-prolonging care than younger patients (OR 0.23; CI 0.08-0.68), however, they were not more likely to avoid unwanted life-prolonging care than younger patients (OR 1.74; CI 0.87-3.47).ConclusionsLikelihood of a patient's treatment preference being consistent with care differ by age and treatment preferences. Older patients preferring life-prolonging therapies are less likely to receive them than younger patients; middle-aged patients who want to avoid life-prolonging care are more likely to do so than younger patients. Both findings have implications for patients' quality-of-death, indicating a need for further research.

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