This article is more than 5 years old. Information may no longer be current.

Life expectancy not often considered when recommending cancer screenings for older adults

Despite a recommendation to consider it, many primary care physicians do not use life expectancy in their decision-making for cancer screening of older adults, according to study data presented at the American Geriatrics Society Annual Scientific Meeting

“Cancer screening in older adults with limited life expectancy may expose them to risks of screening without benefit,” Nancy Schoenborn, MD, assistant professor of geriatric medicine and gerontology at Johns Hopkins University School of Medicine, and colleagues wrote. “Increasingly, clinical practice recommendations advocate for incorporating patient’s life expectancy in cancer screening to minimize harm.”

Although recommendations advocate the utilization of each patient’s life expectancy, it is unknown how clinicians approach these recommendations, the researchers wrote.

To answer this question, Schoenborn and colleagues conducted individual interviews with 28 PCPs (mean age = 46.2 years) in 2015. Of the participants, 16 were female and 21 were white. Twenty-six were physicians while the other two were nurse practitioners. The interview asked about factors considered in cancer screening decisions for adults older than 65 years, incorporating life expectancy into these decisions, and the physician’s approach to discussing cancer screening.

From the interviews, the researchers identified four themes:

• Not all physicians considered life expectancy relevant in cancer screening of older adults;
• PCPs considered age, screening history, screening test-specific considerations and patient engagement when recommending cancer screening;
• For patients with limited life expectancy, physicians sometimes completely omitted the subject of cancer screening and rarely mentioned life expectancy; and
• When PCPs asked about discontinuing cancer screening, the patient’s reaction ranged from skepticism to relief.

“Despite recommendations to incorporate life expectancy in cancer screening decisions of older adults, PCPs encounter a number of ambiguities in implementing these recommendations,” the researchers wrote. “Clinicians need more clear guidance on how to incorporate life expectancy in cancer screening decisions and how to discuss these decisions.”  – by Will Offit

Reference:

Schoenborn N, et al. Abstract B141. Presented at: the 2016 American Geriatrics Society Annual Scientific Meeting; May 19-20; Long Beach, California.

Disclosure: The researchers report no relevant financial disclosures.