Navigating the Gray Zone: Physicians’ Perspectives on Treatment Decision-Making in Elderly Cancer Patients in Korea

Background: To investigate awareness and perceptions related to treatment decision-making in elderly cancer patients among Korean cancer physicians. Methods:Online survey was conducted from July to August 2022 among medical doctors working at general or tertiary general hospitals in Korea involved in treatment decision-making for elderly cancer patients.The questionnaire comprised single or multiple choice questions in four parts.Results: 382 Cancer physicians participated in this survey, 82.2% agreed that they would be less inclined to treat the patients if they were older, and among these participants, 91.8% reported the age threshold for less intensive treatment to be over 75 years.The top choice for the most important factor was "patient's decision" (24.9%)."Functional status" (94.8%) ranked highest in importance agreement for the factors, followed by "patient decision", "patient frailty", and "cancer stage"."I modify treatment plans for older cancer patients to take into account their level of frailty and overall functional status" had the highest agreement rate as a clinical practice in the treatment of elderly cancer patients (91.6%).Among the respondents, 85.1% agreed that it is necessary to develop clinical practice guidelines related to cancer treatment for the elderly, and also 'development of clinical guidelines' was the highest item as an area in need of improvement in treatment decision-making (38.7%). Conclusion:In our study, we found that patient decision-making and functional status were important considerations in treatment decisions for older cancer patients.The development and dissemination of relevant clinical guidelines are needed to improve treatment decision-making for older cancer patients.