Cancer Screening in Older Adults: Individualized Decision-Making and Communication Strategies.
Cancer Screening in Older Adults: Individualized Decision-Making and Communication Strategies.
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DOI：
10.1016/j.mcna.2020.08.002
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发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Walter LC
中科院分区：
文献类型：
--
作者：
Kotwal AA;Walter LC
National recommendations for cancer screening have changed significantly in recent years for older adults. 1 Changes have been related to an increased recognition that cancer screening decisions are often complex in adults who are older than 75 years. While many older adults have substantial life expectancy and are in good health, the majority of randomized controlled trials (RCTs) of cancer screening tests have not included adults over the age of 75 years old. 2 Consequently, it can be unclear when it is appropriate to extrapolate potential benefits to individual older adults seen in clinic. Moreover, there is accumulating evidence of potential harms of cancer screening. 3 For example, older adults who are frail or who have many co-morbid medical conditions may experience greater rates of complications from follow-up procedures to screening tests and be unaware of “diagnostic cascades” following positive tests. Overdiagnosis, or the diagnosis and treatment of a cancer that would not have caused symptoms during an individual’s remaining lifetime, occurs more frequently among older adults with less than a 10-year life expectancy, potentially exposing them to the harms of testing and treatment (including surgeries, chemotherapy, and radiation) without benefits. 4 Moreover, in typical time-limited primary care settings, discussions about cancer screening may take time away from discussing interventions for treating known comorbid diseases, such as heart disease, or reducing polypharmacy.
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