Individualizing Cancer Screening in Older Adults: A Narrative Review and Framework for Future Research
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Older adults often have multiple chronic conditions that may decrease additional life expectancy. Research evaluating the benefits and harms of screening must include consideration of competing morbidities and patient heterogeneity (beyond age), potentially increased harms of screening, and patient preferences. Other areas in need of additional research include the lack of evidence for older adults on the harms of screening tests; the overdiagnosis of disease; the burden of disease labeling; the effects of inaccurate test results; the harms of disease treatment; and harms related to prioritization of healthcare (e.g., for a particular patient, lifestyle counseling may be more important than screening). Nontraditional outcomes, such as the effects on family caregivers, are also relevant. Studies comparing trajectories of quality-adjusted survival with and without screening to assess net benefit are typically lacking. There is little evidence on the preferences of older adults for deciding whether to be screened, the process of being screened, and the health states associated with being or not being screened. To enhance the quality and quantity of evidence, older adults need to be enrolled in screening trials and clinical studies. Measures of functional status and health-related quality of life (HRQL) need to be included in trials, registries, and cohort studies. This article addresses these challenges, and presents a framework for what research is needed to better inform screening decisions in older adults.
KEY WORDSolder adults cancer screening patient preferences
Dr. Erica S. Breslau, PhD at the National Cancer Institute, Dr. Roger Chou, MD at Oregon Health and Science University, Dr. Bruce Kinosian, MD at the University of Pennsylvania, Dr. Tracy Wolff, MD, MPH at the Agency for Healthcare Research and Quality, and Tracy Beil, MS and Debra Burch at the Center for Health Research.
Agency for Health Care Research; National Cancer Institute (Dr. Eckstrom, Dr. Feeny, and Ms. Perdue). Dr. Walter’s effort was supported by the National Cancer Institute (grant number R01 CA134425) and the National Institute on Aging (grant number K24AG041180).
1st Annual Healthy Aging Conference of the Healthy Aging Alliance, Portland, OR, October 27, 2011; 64th Annual Scientific Meeting, The Gerontological Society of America, Boston, MA, November 18–22, 2011.
Conflict of Interest
David H. Feeny has a proprietary interest in Health Utilities Incorporated, Dundas, Ontario, Canada. HUInc. distributes copyrighted Health Utilities Index (HUI) materials and provides methodological advice on the use of HUI. The other authors declare that they do not have a conflict of interest to report.
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