Urban-rural disparities in clinical decision-making for older adults with cancer in Japan: Results from a nationwide survey.

INTRODUCTION

Japan has an ageing population and the highest proportion of the population aged 75 years and older worldwide. Geriatric assessment (GA) tools are recommended for optimising cancer treatment in older adults. This study assessed the use of GA tools for older adults with cancer in Japan by the level of urbanisation.

MATERIALS AND

METHODS

A nationwide web-based questionnaire survey of Japanese Society of Medical Oncology members was conducted in October 2024. Respondents were asked how they defined "older adults with cancer," including considerations such as chronological age, functional status, cognitive function, comorbidities, frailty, and use of GA tools, and the criteria used for treatment decision-making at their institutions. Level of urbanisation was defined as rural (〈200,000), semi-urban (200,000-999,999), or urban (≥1,000,000), based on the population size of the municipality in which the respondent's facility was located.

RESULTS

Of 884 respondents, 717 were included in the analysis. The criteria used to identify older adults with cancer were based on age, activities of daily living (ADL), instrumental activities of daily living (IADL), and cognitive function, with differences according to the level of urbanisation. Only 41.3% of respondents reported using GA tools, of which G8 and ADL/IADL were the most widely used. Respondents in urban areas were more likely to report that their institution recommended use of GA tools (39.5% vs 29.7%), to accept longer travel times for treatment (46.2% vs 39.1%), and to report not considering life expectancy when recommending active treatment (47.0% vs 41.1%) than those in rural areas. Many respondents in rural areas reported practical barriers to treatment continuation, including lack of caregivers and transportation.

DISCUSSION: The use of GA tools differed by level of urbanisation. The use of GA tools needs to be promoted, and urban-rural disparities in their use addressed.