Martine T E Puts1, Brianne Tapscott2, Margaret Fitch2, Doris Howell3, Johanne Monette4, Doreen Wan-Chow-Wah4, Monika Krzyzanowska5, Nathasha B Leighl5, Elena Springall6, Shabbir M Alibhai7. 1. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. Electronic address: martine.puts@utoronto.ca. 2. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. 3. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Department of Oncology Nursing, Princess Margaret Cancer Centre, Toronto, Canada. 4. Division of Geriatric Medicine, and McGill University/Université de Montreal Solidage Research Group on Frailty and Aging, Jewish General Hospital, Montreal, Canada. 5. Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada. 6. Gerstein Science Information Centre, University of Toronto Libraries, Toronto, Canada. 7. Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Canada.
Abstract
BACKGROUND: Cancer is a disease that affects mostly older adults. Older adults often have other chronic health conditions in addition to cancer and may have different health priorities, both of which can impact cancer treatment decision-making. However, no systematic review of factors that influence an older cancer patient's decision to accept or decline cancer treatment has been conducted. MATERIALS AND METHODS: Systematic review of the literature published between inception of the databases and February 2013. Dutch, English, French or German articles reporting on qualitative studies, cross-sectional, longitudinal observational or intervention studies describing factors why older adults accepted or declined cancer treatment examining actual treatment decisions were included. Ten databases were used. Two independent reviewers reviewed manuscripts and performed data abstraction using a standardized form and the quality of studies was assessed with the Mixed Methods Appraisal Tool. RESULTS: Of 17,343 abstracts reviewed, a total of 38 studies were included. The majority focused on breast and prostate cancer treatment decisions and most studies used a qualitative design. Important factors for accepting treatment were convenience and success rate of treatment, seeing necessity of treatment, trust in the physician and following the physician's recommendation. Factors important for declining cancer treatment included concerns about the discomfort of the treatments, fear of side effects and transportation difficulties. CONCLUSION: Although the reasons why older adults with cancer accepted or declined treatment varied considerably, the most consistent determinant was physician recommendation. Further studies using large, representative samples and exploring decision-making incorporating health literacy and comorbidity are needed.
BACKGROUND:Cancer is a disease that affects mostly older adults. Older adults often have other chronic health conditions in addition to cancer and may have different health priorities, both of which can impact cancer treatment decision-making. However, no systematic review of factors that influence an older cancerpatient's decision to accept or decline cancer treatment has been conducted. MATERIALS AND METHODS: Systematic review of the literature published between inception of the databases and February 2013. Dutch, English, French or German articles reporting on qualitative studies, cross-sectional, longitudinal observational or intervention studies describing factors why older adults accepted or declined cancer treatment examining actual treatment decisions were included. Ten databases were used. Two independent reviewers reviewed manuscripts and performed data abstraction using a standardized form and the quality of studies was assessed with the Mixed Methods Appraisal Tool. RESULTS: Of 17,343 abstracts reviewed, a total of 38 studies were included. The majority focused on breast and prostate cancer treatment decisions and most studies used a qualitative design. Important factors for accepting treatment were convenience and success rate of treatment, seeing necessity of treatment, trust in the physician and following the physician's recommendation. Factors important for declining cancer treatment included concerns about the discomfort of the treatments, fear of side effects and transportation difficulties. CONCLUSION: Although the reasons why older adults with cancer accepted or declined treatment varied considerably, the most consistent determinant was physician recommendation. Further studies using large, representative samples and exploring decision-making incorporating health literacy and comorbidity are needed.
Authors: Nimali Jayasinghe; B Isabel Moallem; Margo Kakoullis; Mary-Jane Ojie; Lili Sar-Graycar; Katarzyna Wyka; M Cary Reid; John P Leonard Journal: Gerontologist Date: 2019-01-09
Authors: James M Wilson; David P Dearnaley; Isabel Syndikus; Vincent Khoo; Alison Birtle; David Bloomfield; Ananya Choudhury; John Graham; Catherine Ferguson; Zafar Malik; Julian Money-Kyrle; Joe M O'Sullivan; Miguel Panades; Chris Parker; Yvonne Rimmer; Christopher Scrase; John Staffurth; Andrew Stockdale; Clare Cruickshank; Clare Griffin; Emma Hall Journal: Int J Radiat Oncol Biol Phys Date: 2018-01-09 Impact factor: 7.038