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 which affect diagnosis. Design and setting: Systematic literature review. Method: Electronic databases were searched for studies of patients over 65, presenting with cancer symptoms to primary care considering diagnostic decisions. Studies were analysed using thematic synthesis and according to the Synthesis Without Meta-analysis (SWiM) guidelines. Results: Data from 54 studies with 230729 participants are included. The majority of studies suggest an association between increasing age and prolonged diagnostic interval or deferral of a decision to investigate cancer symptoms. Thematic synthesis highlighted three important factors which resulted in uncertainty in decisions involving older adults: frailty, co-morbidities and cognitive impairment. The 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.
- Received April 14, 2021.
- Accepted September 27, 2021.
- Copyright © 2021, The Authors
This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)