Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway.
BMC Cancer. 2018 May 9;18(1):546. doi: 10.1186/s12885-018-4456-9.
Patient age is among the most controversial patient characteristics in clinical decision making. In personalized cancer medicine it is important to understand how individual characteristics do affect practice and how to appropriately incorporate such factors into decision making. Some argue that using age in decision making is unethical, and how patient age should guide cancer care is unsettled. This article provides an overview of the use of age in clinical decision making and discusses how age can be relevant in the context of personalized medicine.
We conducted a scoping review, searching Pubmed for English references published between 1985 and May 2017. References concerning cancer, with patients above the age of 18 and that discussed age in relation to diagnostic or treatment decisions were included. References that were non-medical or concerning patients below the age of 18, and references that were case reports, ongoing studies or opinion pieces were excluded. Additional references were collected through snowballing and from selected reports, guidelines and articles.
Three hundred and forty-seven relevant references were identified. Patient age can have many and diverse roles in clinical decision making: Contextual roles linked to access (age influences how fast patients are referred to specialized care) and incidence (association between increasing age and increasing incidence rates for cancer); patient-relevant roles linked to physiology (age-related changes in drug metabolism) and comorbidity (association between increasing age and increasing number of comorbidities); and roles related to interventions, such as treatment (older patients receive substandard care) and outcome (survival varies by age).
Patient age is integrated into cancer care decision making in a range of ways that makes it difficult to claim age-neutrality. Acknowledging this and being more transparent about the use of age in decision making are likely to promote better clinical decisions, irrespective of one's normative viewpoint. This overview also provides a starting point for future discussions on the appropriate role of age in cancer care decision making, which we see as crucial for harnessing the full potential of personalized medicine.
患者年龄是临床决策中最具争议的患者特征之一。在个体化癌症医学中，了解个体特征如何影响实践以及如何将这些因素适当纳入决策是很重要的。有人认为，在决策中使用年龄是不道德的，如何指导癌症护理的患者年龄尚未确定。本文概述了年龄在临床决策中的使用，并讨论了年龄在个体化医学中的相关性。
我们进行了范围界定综述，在 1985 年至 2017 年 5 月期间，在 Pubmed 上搜索英文参考文献。纳入的参考文献涉及癌症，患者年龄在 18 岁以上，且讨论了年龄与诊断或治疗决策的关系。排除了非医学文献、涉及 18 岁以下患者的文献、病例报告、正在进行的研究或观点文章。通过滚雪球法和选定的报告、指南和文章收集了额外的参考文献。
确定了 347 篇相关参考文献。患者年龄在临床决策中有许多不同的作用：与获取相关的背景作用（年龄影响患者向专科护理转诊的速度）和发病率（年龄与癌症发病率增加相关）；与生理相关的患者相关作用（与药物代谢相关的年龄相关变化）和合并症（与年龄增加和合并症数量增加相关）；与干预相关的作用，如治疗（老年患者接受标准以下的护理）和结局（生存率因年龄而异）。
患者年龄以多种方式融入癌症护理决策，使得很难声称年龄中立。承认这一点，并更加透明地使用年龄进行决策，可能会促进更好的临床决策，而不论其规范观点如何。本综述还为未来讨论在癌症护理决策中适当使用年龄提供了一个起点，我们认为这对于充分发挥个体化医学的潜力至关重要。
