Individualizing cancer screening in older adults

A narrative review and framework for future research

Elizabeth Eckstrom, David H. Feeny, Louise C. Walter, Leslie A. Perdue, Evelyn P. Whitlock

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Older adults often have multiple chronic conditions that may decrease additional life expectancy. Research evaluating the benefits and harms of screening must include consideration of competing morbidities and patient heterogeneity (beyond age), potentially increased harms of screening, and patient preferences. Other areas in need of additional research include the lack of evidence for older adults on the harms of screening tests; the overdiagnosis of disease; the burden of disease labeling; the effects of inaccurate test results; the harms of disease treatment; and harms related to prioritization of healthcare (e.g., for a particular patient, lifestyle counseling may be more important than screening). Nontraditional outcomes, such as the effects on family caregivers, are also relevant. Studies comparing trajectories of quality-adjusted survival with and without screening to assess net benefit are typically lacking. There is little evidence on the preferences of older adults for deciding whether to be screened, the process of being screened, and the health states associated with being or not being screened. To enhance the quality and quantity of evidence, older adults need to be enrolled in screening trials and clinical studies. Measures of functional status and health-related quality of life (HRQL) need to be included in trials, registries, and cohort studies. This article addresses these challenges, and presents a framework for what research is needed to better inform screening decisions in older adults.

Original languageEnglish (US)
Pages (from-to)292-298
Number of pages7
JournalJournal of General Internal Medicine
Volume28
Issue number2
DOIs
StatePublished - Feb 2013

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Early Detection of Cancer
Research
Patient Preference
Life Expectancy
Caregivers
Registries
Life Style
Counseling
Cohort Studies
Quality of Life
Morbidity
Delivery of Health Care
Survival
Health
Therapeutics

Keywords

  • cancer screening
  • older adults
  • patient preferences

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Individualizing cancer screening in older adults : A narrative review and framework for future research. / Eckstrom, Elizabeth; Feeny, David H.; Walter, Louise C.; Perdue, Leslie A.; Whitlock, Evelyn P.

In: Journal of General Internal Medicine, Vol. 28, No. 2, 02.2013, p. 292-298.

Research output: Contribution to journalArticle

Eckstrom, Elizabeth ; Feeny, David H. ; Walter, Louise C. ; Perdue, Leslie A. ; Whitlock, Evelyn P. / Individualizing cancer screening in older adults : A narrative review and framework for future research. In: Journal of General Internal Medicine. 2013 ; Vol. 28, No. 2. pp. 292-298.
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