Australian society is aging and as cancer incidence increases with age, the care of older people with cancer is a growing concern.

Aims: To explore the experiences and views of healthcare professionals caring for older people with cancer.

Methods: In this qualitative research, semi structured interviews were conducted with 18 healthcare professionals from a variety of disciplines working in cancer care. Interviews were audiotaped and transcribed. Consecutive interviews were continued until saturation of themes occurred. A thematic analysis was undertaken, which was reviewed by a second investigator with points of divergence discussed and consensus reached.

Results: The overarching theme to emerge was of competing tensions arising in the treatment decision making for older people with cancer. Age was a consistent factor in treatment decisions for those over 80. At the same time as describing modifications to management for those over 80, the importance of not using chronological age as a determining factor was emphasised. There was great concern about causing harm to older people through treatment adverse events. At the same time, the importance of not undertreating an older people based on their age was emphasised. Tension also arose in family involvement. Family were relied upon to enable outpatient treatment yet sometimes forgotten in treatment discussions, whilst at other times family became the decision makers leading to concerns about patient wishes being overridden.

Conclusions: Explicit discussion about the influence of age may aid in determining its role in decision making. Healthcare professionals need to ensure careful balance in family involvement, involving family to the extent the patient desires whilst ensuring the older person is enabled to express their views and wishes.