A systematic review of factors influencing older adults' decision to accept or decline cancer treatment

Cancer Treat Rev. 2015 Feb;41(2):197-215. doi: 10.1016/j.ctrv.2014.12.010. Epub 2014 Dec 26.


Background: Cancer is a disease that affects mostly older adults. Older adults often have other chronic health conditions in addition to cancer and may have different health priorities, both of which can impact cancer treatment decision-making. However, no systematic review of factors that influence an older cancer patient's decision to accept or decline cancer treatment has been conducted.

Materials and methods: Systematic review of the literature published between inception of the databases and February 2013. Dutch, English, French or German articles reporting on qualitative studies, cross-sectional, longitudinal observational or intervention studies describing factors why older adults accepted or declined cancer treatment examining actual treatment decisions were included. Ten databases were used. Two independent reviewers reviewed manuscripts and performed data abstraction using a standardized form and the quality of studies was assessed with the Mixed Methods Appraisal Tool.

Results: Of 17,343 abstracts reviewed, a total of 38 studies were included. The majority focused on breast and prostate cancer treatment decisions and most studies used a qualitative design. Important factors for accepting treatment were convenience and success rate of treatment, seeing necessity of treatment, trust in the physician and following the physician's recommendation. Factors important for declining cancer treatment included concerns about the discomfort of the treatments, fear of side effects and transportation difficulties.

Conclusion: Although the reasons why older adults with cancer accepted or declined treatment varied considerably, the most consistent determinant was physician recommendation. Further studies using large, representative samples and exploring decision-making incorporating health literacy and comorbidity are needed.

Keywords: Aged; Cancer; Geriatric oncology; Treatment preferences; Treatment refusal; Treatment-decision-making.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects*
  • Breast Neoplasms / psychology
  • Breast Neoplasms / therapy
  • Choice Behavior*
  • Communication
  • Comorbidity
  • Decision Making
  • Female
  • Humans
  • Male
  • Neoplasms / economics
  • Neoplasms / psychology*
  • Neoplasms / therapy*
  • Patient Acceptance of Health Care* / psychology
  • Patient Acceptance of Health Care* / statistics & numerical data
  • Prostatic Neoplasms / psychology
  • Prostatic Neoplasms / therapy
  • Qualitative Research
  • Radiotherapy, Adjuvant / adverse effects*
  • Treatment Refusal* / psychology
  • Treatment Refusal* / statistics & numerical data


  • Antineoplastic Agents