Faculty of Medicine of the University of Porto, Porto, Portugal; João de Barros Barreto University Hospital, Federal University of Pará, Belém-Pará, Brazil.
Faculty of Medicine of the University of Porto, Porto, Portugal; IMIP, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil.
Ann Palliat Med. 2021 Apr;10(4):4868-4877. doi: 10.21037/apm-20-2439. Epub 2021 Apr 7.
The literature about the factors associated with cancer treatment refusal, especially by the older patients is scarce. Therefore, this study aimed to identify predictive factors associated with treatment refusal by older patients with cancer. A systematic review was conducted using three databases, Medline, Web of Science, and Scopus with the key concepts, "refusal treatment" and "cancer" and "decision making" and "elderly" or "aged". The search took place in July 2020 and it included articles published in the last 5 years. Of the 211 articles found, 22 were included in the review. Most studies have focused on head and neck and breast cancer treatment decisions and used a quantitative design. The majority of studies evaluated refusal of surgery interventions. Important factors associated with refusal cancer treatment include gender, marital status, race, having government insurance, advanced cancer, poor performance status (cancer stage III or IV) and Charlson Comorbidity Index ≥2. Thus, there are socio-demographic and clinical variables associated with treatment refusal. More studies with the elderly are needed. Understanding these factors may be useful to recognize situations where active education and support can help elderly patients accept optimal care.
关于癌症治疗拒绝相关因素的文献，尤其是老年患者的相关因素的文献十分匮乏。因此，本研究旨在确定与老年癌症患者治疗拒绝相关的预测因素。本研究使用 Medline、Web of Science 和 Scopus 这三个数据库，以“拒绝治疗”和“癌症”以及“决策”和“老年人”或“高龄”为关键概念，进行了系统综述。检索于 2020 年 7 月进行，纳入了过去 5 年发表的文章。在 211 篇文章中，有 22 篇被纳入综述。大多数研究都集中在头颈部和乳腺癌的治疗决策上，并采用了定量设计。大多数研究评估了拒绝手术干预的情况。与癌症治疗拒绝相关的重要因素包括性别、婚姻状况、种族、拥有政府保险、晚期癌症、较差的表现状态（癌症 III 或 IV 期）和 Charlson 合并症指数≥2。因此，存在与治疗拒绝相关的社会人口统计学和临床变量。需要更多针对老年人的研究。了解这些因素可能有助于识别需要积极教育和支持的情况，以帮助老年患者接受最佳治疗。
