Jones, D orcid.org/0000-0003-3833-6055, Di Martino, E, Bradley, SH orcid.org/0000-0002-2038-2056 et al. (8 more authors) (2022) Factors affecting the decision to investigate older adults with potential cancer symptoms: a systematic review. British Journal of General Practice, 72 (714). e1-e10. ISSN 0960-1643
Abstract
Background: Older age and frailty increase the risk of morbidity and mortality from cancer surgery and intolerance of chemotherapy and radiotherapy. The effect of old age on diagnostic intervals is unknown; however, older adults need a balanced approach to the diagnosis and management of cancer symptoms, considering the benefits of early diagnosis, patient preferences, and the likely prognosis of a cancer.
Aim: To examine the association between older age and diagnostic processes for cancer, and the specific factors that affect diagnosis.
Design and setting: A systematic literature review.
Method: Electronic databases were searched for studies of patients aged >65 years presenting with cancer symptoms to primary care considering diagnostic decisions. Studies were analysed using thematic synthesis and according to the Synthesis Without Meta-analysis guidelines.
Results: Data from 54 studies with 230 729 participants were included. The majority of studies suggested an association between increasing age and prolonged diagnostic interval or deferral of a decision to investigate cancer symptoms. Thematic synthesis highlighted three important factors that resulted in uncertainty in decisions involving older adults: presence of frailty, comorbidities, and cognitive impairment. Data suggested patients wished to be involved in decision making, but the presence of cognitive impairment and the need for additional time within a consultation were significant barriers.
Conclusion: This systematic review has highlighted uncertainty in the management of older adults with cancer symptoms. Patients and their family wished to be involved in these decisions. Given the uncertainty regarding optimum management of this group of patients, a shared decision-making approach is important.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The Authors. This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/). |
Keywords: | cancer; decision making, shared; early detection of cancer; frail elderly; primary health care; systematic review |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Academic Unit of Elderly Care and Rehabilitation (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Academic Unit of Health Economics (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 29 Nov 2021 12:43 |
Last Modified: | 25 Jun 2023 22:50 |
Status: | Published |
Publisher: | Royal College of General Practitioners |
Identification Number: | 10.3399/BJGP.2021.0257 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:180716 |