The Impact of Dementia on Cancer Treatment Decision-Making, Cancer Treatment, and Mortality: A Mixed Studies Review
A partir d'une revue de la littérature publiée entre 2004 et 2020 (55 études), cette étude analyse l'effet d'une démence sur la prise de décision thérapeutique, sur les traitements anticancéreux reçus et sur la mortalité, chez les patients âgés atteints d'un cancer
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) and hazard ratios (HRs) 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.
JNCI Cancer Spectrum 2021