Refusal of medical treatment by older adults with cancer: a systematic review

Abstract

The literature about the factors associated with cancer treatment refusal, especially by the older patients is scarce. Therefore, this study aimed to identify predictive factors associated with treatment refusal by older patients with cancer. A systematic review was conducted using three databases, Medline, Web of Science, and Scopus with the key concepts, "refusal treatment" and "cancer" and "decision making" and "elderly" or "aged". The search took place in July 2020 and it included articles published in the last 5 years.Of the 211 articles found, 22 were included in the review. Most studies have focused on head and neck and breast cancer treatment decisions and used a quantitative design. The majority of studies evaluated refusal of surgery interventions. Important factors associated with refusal cancer treatment include gender, marital status, race, having government insurance, advanced cancer, poor performance status (cancer stage III or IV) and Charlson Comorbidity Index ≥2. Thus, there are socio-demographic and clinical variables associated with treatment refusal. More studies with the elderly are needed. Understanding these factors may be useful to recognize situations where active education and support can help elderly patients accept optimal care.

Determinants of Patient Refusal of Postoperative Radiation Therapy in Sinonasal Squamous Cell Carcinoma

“…Previous studies have identified advanced age, low educational status, and higher comorbidities as factors correlated with refusal of cancer treatment. 8 9 10 11…”

The impact of patient preference in the treatment algorithm for recurrent/metastatic head and neck squamous cell carcinoma

“…Contrary to the previous papers assessing ranking of preference and priority, the main findings from studies on laryngeal preservation suggested that ''live longer" is not the main expectancy. Laryngeal cancer patients mostly preferred radiation treatment alone or in combination with chemotherapy than laryngectomy in order to preserve voice and speech [25,[39][40][41][42]. Notably, the inclusion of RM HNSCC in the aforementioned experiences is underrepresented (22% of patients in the subgroup of palliative treatment [31]) or completely missing.…”

Barriers in Advance Care Planning and Goals of Care Discussion With Oncology Patients: The Perspective of Brazilian Medical Residents

“…These di culties were further strati ed into barriers related to patients, doctors and/or related to the health system or external factors. It is a Likert questionnaire where each session has statements about the di culties in discussing the advance care planning, classi ed from 1 to 7 points, where 1 is the extremely unimportant di culty; 2, very unimportant; 3, little unimportant; 4,neither important nor unimportant; 5, little important; 6,very important; and 7, extremely important 3 .…”

“…1,2 One of the principles of good care is respect and receptivity to patients' wishes and values; thus, it is important to understand patients' perspectives about cancer treatment. 3 High-intensity life support is often provided even when patients or their families may prefer to focus on comfort care, in spite of evidence suggesting that use of unwanted technology is associated with negative outcomes, such as decreased quality of life and low satisfaction with end-of-life care 4 . Robust evidence shows that ACP is associated with a wide variety of bene ts, such as: less moral distress by health care professionals, higher rates of advanced directives (AD) registrations, reduced hospitalization, intensive and futile treatment at the end-of-life, greater probability of the patient dying in the chosen place, greater satisfaction with the quality of care, and less risk of stress, anxiety and depression in family members during bereavement.…”