The Impact of Dementia on Cancer Treatment Decision-Making, Cancer Treatment, and Mortality: A Mixed Studies Review.
The Impact of Dementia on Cancer Treatment Decision-Making, Cancer Treatment, and Mortality: A Mixed Studies Review.
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DOI：
10.1093/jncics/pkab002
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发表时间：
2021-06
影响因子：
4.4
通讯作者：
Liu B
中科院分区：
文献类型：
--
作者：
Caba Y;Dharmarajan K;Gillezeau C;Ornstein KA;Mazumdar M;Alpert N;Schwartz RM;Taioli E;Liu B
老年痴呆症和癌症常见于老年人。然而，人们对痴呆症对癌症治疗和癌症患者预后的影响知之甚少，也没有指导方针。我们进行了一项混合研究回顾，以评估痴呆症对癌症治疗决策、癌症治疗和死亡率影响的当前知识和差距。在PubMed、Medline和PsycINFO中检索了2004年1月至2020年2月以英文发表的55项关于在癌症诊断和/或共病癌症和痴呆之前诊断为痴呆症的老年人的研究。我们在适当的情况下使用定量估计的范围，即优势比（ORs）、风险比（hr）和风险比（RR）来描述可变性，并对定性数据进行叙述性回顾。痴呆患者更容易接受无法治愈的治疗（包括临终关怀或姑息治疗）（or， HR， RR范围= 0.40-4.4,n = 8），而较少接受化疗（or， HR范围= 0.11-0.68,n = 8）、放疗（or范围= 0.24-0.56,n = 2）和手术（or范围= 0.30-1.3,n = 4）。老年癌症合并痴呆患者的死亡率高于单纯癌症患者（HR和OR范围= 0.92-5.8,n = 33）。定性研究的总结结果一致表明，临床医生、护理人员和患者倾向于不太积极的护理，对痴呆症患者的生活质量给予更高的优先级，而不是预期寿命。目前在癌症和痴呆患者的治疗决策方面的做法是不一致的。考虑到患者和护理人员的观点，迫切需要为这一不断增长的患者群体制定治疗指南。
Dementia and cancer occur commonly in older adults. Yet, little is known about the effect of dementia on cancer treatment and outcomes in patients diagnosed with cancer, and no guidelines exist. We performed a mixed studies review to assess the current knowledge and gaps on the impact of dementia on cancer treatment decision-making, cancer treatment, and mortality. A search in PubMed, Medline, and PsycINFO identified 55 studies on older adults with a dementia diagnosis before a cancer diagnosis and/or comorbid cancer and dementia published in English from January 2004 to February 2020. We described variability using range in quantitative estimates, ie, odds ratios (ORs), hazard ratios (HRs), and risk ratios (RR) when appropriate and performed narrative review of qualitative data. Patients with dementia were more likely to receive no curative treatment (including hospice or palliative care) (OR, HR, and RR range = 0.40-4.4, n = 8), while less likely to receive chemotherapy (OR and HR range = 0.11-0.68, n = 8), radiation (OR range = 0.24-0.56, n = 2), and surgery (OR range = 0.30-1.3, n = 4). Older adults with cancer and dementia had higher mortality than those with cancer alone (HR and OR range = 0.92-5.8, n = 33). Summarized findings from qualitative studies consistently revealed that clinicians, caregivers, and patients tended to prefer less aggressive care and gave higher priority to quality of life over life expectancy for those with dementia. Current practices in treatment-decision making for patients with both cancer and dementia are inconsistent. There is an urgent need for treatment guidelines for this growing patient population that considers patient and caregiver perspectives.
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