Hospital Clínico Universitario de Valencia, Valencia, Spain.
Andalusian School of Public Health (EASP), Granada, Spain.
Front Public Health. 2024 Sep 4;12:1421940. doi: 10.3389/fpubh.2024.1421940. eCollection 2024.
Cancer is a major public health problem worldwide, given its magnitude and growing burden, in addition to the repercussions on health and quality of life. Palliative care can play an important role improving quality of life and it is cost-effective, but some population groups may not benefit from it or benefit less based on age and gender inequalities. The aim of this systematic review was to analyze the available evidence on age- and gender-based social inequalities in access to and use of palliative care in cancer patients.
A systematic review was conducted following the PRISMA guidelines. An exhaustive literature research was performed in Pubmed, CINHAL and Embase until November 2022 and were not restricted by language or date of publication. Eligible studies were observational studies analyzing the access and use of palliative care in cancer patients.
Fifty-three studies were included in the review. Forty-five analyzed age and 44 analyzed gender inequalities in relation to use of and access to palliative care. Our results show that older people receive poorer quality of care, worst symptom control and less preferences for palliative care. In relation to gender, women have a greater preference for the use of palliative care and generally have more access to basic and specialized palliative care services and palliative care facilities.
This review reveals difficulties for older persons and men for access to key elements of palliative care and highlights the need to tackle access barriers for the most vulnerable population groups. Innovative collaborative services based around patient, family and wider community are needed to ensure optimal care.
鉴于癌症的规模和不断增加的负担，以及对健康和生活质量的影响，癌症是一个全球性的主要公共卫生问题。姑息治疗可以在提高生活质量方面发挥重要作用，并且具有成本效益，但一些人群可能无法从中受益，或者基于年龄和性别不平等而受益较少。本系统评价的目的是分析癌症患者获得和使用姑息治疗方面存在的基于年龄和性别的社会不平等的现有证据。
按照 PRISMA 指南进行系统评价。在 2022 年 11 月之前，在 Pubmed、CINHAL 和 Embase 中进行了详尽的文献检索，且不受语言或发表日期的限制。纳入的研究为分析癌症患者姑息治疗的获得和使用情况的观察性研究。
共纳入 53 项研究。其中 45 项研究分析了年龄不平等与姑息治疗的使用和获得之间的关系，44 项研究分析了性别不平等与姑息治疗的使用和获得之间的关系。我们的结果表明，老年人接受的护理质量较差，症状控制更差，对姑息治疗的偏好较低。关于性别，女性更倾向于使用姑息治疗，并且通常更容易获得基本和专业的姑息治疗服务和姑息治疗设施。
本综述揭示了老年人和男性在获得姑息治疗关键要素方面的困难，并强调需要解决最弱势群体的获得障碍。需要以患者、家庭和更广泛的社区为中心的创新协作服务，以确保提供最佳护理。
