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Geriatric Oncology A Systematic Review of Factors Influencing Older Adults’ Hypothetical Treatment Decisions Martine T Puts, RN, PhD, 1 Brianne Tapscott, RN, BScN, 2 Margaret Fitch, RN, PhD, 3 Doris Howell, RN, PhD, 4,5 Johanne Monette, MD, MSc, 6 Doreen Wan-Chow-Wah, MD, 7 Monika K Krzyzanowska, MD, MPH, 8,9 Natasha B Leighl, MD, BSc, MSc, 8,9 Elena Springall, MSc 10 and Shabbir M Alibhai, MD, MSc 11 1. Assistant Professor, Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; 2. Registered Nurse, Children’s Hospital of Eastern Ontario, Ontario, Canada; 3. Expert Lead/Program Consultant, Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; 4. Associate Professor, Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; 5. RBC Chair Oncology Nursing, Department of Oncology Nursing, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; 6. Assistant Professor and Geriatrician, Division of Geriatric Medicine, and Co-Director of McGill University/ Université de Montreal Solidage Research Group on Frailty and Aging, Jewish General Hospital, Montreal, Quebec, Canada; 7. Medical Director, Consultation Service for Senior Oncology Patients, Division of Geriatric Medicine, Jewish General Hospital, Montreal, Quebec, Canada; 8. Medical Oncologist, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; 9. Associate Professor, University of Toronto, Toronto, Ontario, Canada; 10. Acting Coordinator of Resource Sharing, Gerstein Science Information Centre, University of Toronto Libraries, Toronto, Ontario, Canada; 11. Senior Scientist and Staff Physician, University Health Network and University of Toronto, Toronto, Ontario, Canada Abstract Purpose: Cancer affects mostly older adults and although research has shown that a significant proportion of seniors do not receive treatment, little is known about the reasons why. Therefore, we conducted a systematic review of reasons why older adults accept or decline cancer treatments. Design: Systematic review of studies reporting on hypothetical cancer treatment scenarios in older patients published between inception of 10 databases and February 2013. Results: Of 17,343 abstracts reviewed, a total of 12 studies were included (sample size 21 to 511). The willingness to be treated varied by the benefits of treatment (ranging from never to always accepting the treatment), the particular side effects of treatment, and previous treatments received/previous treatment experiences (those who were treated previously were more likely to accept the same treatment). Results showed conflicting findings with regard to the impact of age, education (those with lower/higher age/education wanting more benefits before accepting), and family situation (no effect/those who were single were less likely to accept). Conclusion: Willingness among older adults to be treated was most influenced by the extent of benefits and side effects as well as prior treatment experiences. However, little is known about treatment preferences of the oldest old, those with multimorbidity, and preferences for newer agents. Keywords Systematic review, geriatric oncology, cancer treatment, treatment decision-making, treatment preferences, treatment refusal Disclosure: Martine T Puts, RN, PhD, Brianne Tapscott, RN, BScN, Margaret Fitch, RN, PhD, Doris Howell, RN, PhD, Johanne Monette, MD, MSc, Doreen Wan-Chow-Wah, MD, Monika K Krzyzanowska, MD, MPH, Natasha B Leighl, MD, BSc, MSc, Elena Springall, MSc, and Shabbir M Alibhai, MD, MSc have no conflicts of interest to declare. There were no publication charges associated with this article. Acknowledgments: The authors would like to thank Mr D Stephens who has been involved as a patient representative in this review. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: January 16, 2015 Accepted: March 15, 2015 Citation: Oncology & Hematology Review, 2015;11(1):19–33 Correspondence: Martine T Puts, RN, PhD, Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, Canada M5T 1P8. E: martine.puts@utoronto.ca Support: This work was supported by a knowledge synthesis grant # 119803 from the Canadian Institutes of Health Research to Martine T Puts, RN, PhD. Martine T Puts, RN, PhD is supported with a New Investigator Award from the Canadian Institutes of Health Research. Cancer is a significant health problem in older persons. 1 It is estimated that 42 % of all incident cases and over 60 % of mortality due to cancer occur in persons aged 70 and over. 1,2 With the aging of the population there will Tou ch MEd ica l MEdia be a considerable increase in the number of older adults diagnosed with cancer. 1,2 Treatment decisions are based on preferences, estimation of the risks and benefits, and costs. An individual makes a trade-off between 19