Patient Preferences for Treatment Outcomes in Oncology with a Focus on the Older Patient—A Systematic Review

Abstract

For physicians, it is important to know which treatment outcomes are prioritized overall by older patients with cancer, since this will help them to tailor the amount of information and treatment recommendations. Older patients might prioritize other outcomes than younger patients. Our objective is to summarize which outcomes matter most to older patients with cancer. A systematic review was conducted, in which we searched Embase and Medline on 22 December 2020. Studies were eligible if they reported some form of prioritization of outcome categories relative to each other in patients with all types of cancer and if they included at least three outcome categories. Subsequently, for each study, the highest or second-highest outcome category was identified and presented in relation to the number of studies that included that outcome category. An adapted Newcastle–Ottawa Scale was used to assess the risk of bias. In total, 4374 patients were asked for their priorities in 28 studies that were included. Only six of these studies had a population with a median age above 70. Of all the studies, 79% identified quality of life as the highest or second-highest priority, followed by overall survival (67%), progression- and disease-free survival (56%), absence of severe or persistent treatment side effects (54%), and treatment response (50%). Absence of transient short-term side effects was prioritized in 16%. The studies were heterogeneous considering age, cancer type, and treatment settings. Overall, quality of life, overall survival, progression- and disease-free survival, and severe and persistent side effects of treatment are the outcomes that receive the highest priority on a group level when patients with cancer need to make trade-offs in oncologic treatment decisions.

Age-related differences in cancer relative survival in the US: a SEER-18 analysis

“…For distant cancers, the greatest age-related differences in 1-year RS were observed for colon and rectal cancers with differences of 28 (95% CI: 26-30) and 27 (95% CI: [23][24][25][26][27][28][29][30][31] percentage points respectively, closely followed by ovarian cancer with a difference of 23 points (95% CI: 21-25). For distant liver cancer, there was no difference in survival by age (1-year RS = 14% in 50 to 64 age group and 75 to 84 age group).…”

“…Older adults may be less likely to receive curative treatment, [23][24][25][26][27][28][29] and especially in the face of uncertain prognosis, may be more likely to value quality of life over survival. 30 Second, in the context of a poor evidence base on treatment strategies in older adults, 31 the effectiveness and toxicity of treatment may differ across age groups. Evidence suggests higher posttreatment mortality and increased all-cause mortality in older patients, particularly in frailer ones.…”

Age-related differences in colon and rectal cancer survival: An analysis of United States SEER-18 data

“…Previous research that has examined patient preference and refusal of cancer treatment in older adults has reported that older adults (as younger adults) prioritize quality of life and overall survival. 36 The most consistent determinant of refusal or acceptation of treatment was physician recommendation. 37 Further research on this would be useful to better interpret age-related disparities.…”

What Defines Quality of Life for Older Patients Diagnosed with Cancer? A Qualitative Study

“…For shared decision making, knowing what matters most in life, rather than simply asking whether a patient would want a certain treatment, will give more clarity regarding treatments that should be considered or avoided for an individual patient [ 1 ]. To optimally counsel patients, it is important to know their priorities and how they value outcome options in relation to each other [ 2 ]. In a clinical setting, this also means understanding what quality of life means to the individual.…”