Elsevier

Health Policy

Volume 124, Issue 9, September 2020, Pages 1008-1016
Health Policy

Caring for older cancer patients: A scoping review

https://doi.org/10.1016/j.healthpol.2020.05.002Get rights and content

Highlights

  • Efforts are currently being made worldwide to make of geriatric oncology a recognized medical specialty.

  • The major themes in the literature about geriatric oncology are “Challenges”, “Organization of the discipline” and “Organization of care”.

  • This review could be the first step of many other conversations on each theme and sub-theme as there is a need for more published studies about experiences in geriatric oncology and lessons learned from them.

Abstract

There is a growing recognition among oncologists that older patients differ from other cancer patients. Older patients present age-specific issues affecting the prevention and management of their cancer. Over the years, this has led to the development of the discipline of geriatric oncology, which is the set of practices elaborated to evaluate, treat, follow-up and rehabilitate the population of older cancer patients. Geriatric oncology is still struggling to establish itself in healthcare settings managing older cancer patients. Efforts are currently being made to make it a recognized medical specialty. Health policy makers have to have a grasp of the evolution of this discipline because it concerns a fast growing segment of the cancer patient population.

To shed light on the literature about this field, we undertook a scoping review in which we identified relevant studies; charted the data from the selected studies, collated, summarized and reported the results.

From 2043 references initially identified, we included 92 articles in our scoping review and extracted data from 88 articles. The included articles were classified into three major categories, namely Advancing the discipline, Organization of care and Nursing and support services for patient and their caregivers.

This review affords researchers and policy makers a foundation to help conduct many other conversations on each theme and sub-theme.

Introduction

Population aging is one of the major demographic characteristics of the 21st century. According to the United Nations [1], over the last 50 years, the number of older people has tripled with the 80-and-over age people the fastest growing group. By the year 2050, there will be 395 million persons aged 60 and over in more developed regions (70% increase from 2000 to 2050), and 1.6 billion people in less developed areas (400% increase from 2000 to 2050). Such rapid growth and sharp increase in life expectancy poses inevitable impacts on different social, economic, political, and medical conditions. Aging causes reduction in functional reserve of multiple organ systems, and eventually leads to increasing the chance of different disease in individuals [2] such as cancer [3]. There is a growing recognition among oncologists that older patients differ from other cancer patients and that “there are age-specific issues related to the prevention and management of cancer" [3]. Yet, the practice of geriatric oncology is still struggling to establish itself in many of the healthcare settings in which it exists [4]. Geriatric oncology, gero-oncology, oncogeriatrics are terms that are used interchangeably and have been coined to refer to the practice of oncology focused on older patients. Geriatric oncology relates to the set of practices elaborated to evaluate, treat, follow-up and rehabilitate older cancer patients. Efforts are currently being made to make it a medical specialty. There are about a dozen training programs in geriatrics and oncology across the United States and Canada. Recently, the American Board of Internal Medicine approved a combined fellowship in medical oncology and geriatrics, from which graduates are eligible to be board certified in both specialties. Health policy makers have to have a grasp of the evolution of this field of medical practice that concerns a fast growing segment of the cancer patient population.

To shed light on the literature about this field, we undertook a scoping review following the model of Arskey and O’Malley [5]. A scoping review helps “to map rapidly the key concepts underpinning a research area and the main sources and types of evidence available, and can be undertaken as standalone projects in their own right, especially where an area is complex or has not been reviewed comprehensively before” [5].

Section snippets

Methods

As we aimed to provide a wide survey of the body of literature on geriatric oncology, its evolution and professional role and to identify gaps as well as health policy implications, we undertook a scoping review of the literature. We followed the five steps of the scoping review methodological framework proposed by Arksey and O’Malley [5].

Step 1: identifying the research question

In this scoping review, we tried to answer the following question: What is known from the available literature about

Results

From 2043 references initially identified, 92 articles were finally included in our scoping review, based on our inclusion and exclusion criteria (Fig. 1). However, of these 92 included papers, 4 did not have any information extracted from them due to their format and the redundancy of their content. Therefore, data was extracted from a total of 88 articles. They were published from 1996 to 2016, mostly from Europe (51/88) and the United States (32/88). The remaining articles were originating

Discussion

There is a growing body of literature discussing the care of older cancer patients. The main themes that structure this literature relate to the ways to advance the discipline of geriatric oncology, the organization of care and the role of nurses and support services.

Ethics approval

Not applicable.

Funding sources

This work was supported by the Fond de Recherche Quebec – Santé (FRQS). The latter did not take any part in the study.

Declaration of Competing Interest

None.

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