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Age and Ageing Advance Access originally published online on June 3, 2006
Age and Ageing 2006 35(5):469-476; doi:10.1093/ageing/afl001
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© The Author 2006. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Systematic Review

The effect of age on referral to and use of specialist palliative care services in adult cancer patients: a systematic review

Jenni Burt and Rosalind Raine

Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK

Address correspondence to: J. Burt. Fax: (+44) 020 7813 0280. Email: jenni.burt{at}ucl.ac.uk

Objective: to investigate variations in the use of specialist palliative care (SPC) services for adult cancer patients, in relation to age.

Design: systematic review of studies examining use of or referral to SPC services in adult cancer patients.

Search strategy and selection criteria: six electronic databases (Medline, Embase, Web of Science, HMIC, SIGLE and AgeInfo) were searched for studies published between 1966 and March 2005, and references in the articles identified were also examined. Inclusion criteria were all studies which provided data on age in relation to use of or referral to SPC. Two reviewers independently selected studies, extracted data and assessed methodological quality according to defined criteria.

Main outcome measures: use of or referral to SPC services, determined from all sources of report (patient, informal carer, health care professional, health care records).

Results: 14 studies were identified. All reported a statistically significant lower use of SPC among older cancer patients (65 and above or older) at a univariate level [crude odds ratios ranged from 0.33 (0.15–0.72) to 0.82 (0.80–0.82)]. However, there were important methodological weaknesses in all of the studies identified; most crucially, studies failed to consider variations in use in relation to need for SPC.

Conclusions: there is some evidence that older people are less likely to be referred to, or to use, SPC. These findings require confirmation in studies using prospectively collected data which control for patient’s need for SPC.

Keywords: palliative care, utilisation, age factors, review, systematic review, elderly, cancer, oncology

Received November 1, 2005; accepted in revised form February 2, 2006.


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