Cancer Screening in Healthy Older Adults: Understanding Quality of Life-Evidence

National Cancer Institute, Frederick MD

Investigators

Abstract

Cancer Screening in Healthy Older Adults: Understanding Quality of Life-Evidence Review Further the Evidence Review being pursued by AHRQ to understand Cancer Screening in Healthy Older Adults and the Effect of Quality of Life Measures on Screening Decisions. Support for an analysis of quality of life metrics to include a review of: existing measures, the consistency of current measures, and usefulness of existing measures as outcome measures in evaluating effectiveness of preventive services in older adults. Specifically, few policy statements about cancer screening give guidance about when to consider ending screening in older adults. Decreasing life expectancy, increasing comorbidities, and competing causes of death may be leading to less benefit and potentially more harm from screening interventions in older adults. Life expectancy is also extending and the population of older adults is expanding. In addition the analysis will include how existing measures of quality of life predict or explain decisions about screening, especially with respect to cancer, by older adults. This analysis will fill a recognized need for a thorough understanding of quality of life measures that was identified during a recent review on primary care relevant interventions to prevent onset of functional limitations. With this IAA we propose to address this need and advance the methodologic work in evaluating prevention in older adults. Improved understanding in this area is key to the understanding of factors relevant to cancer screening decision making in older adults. As the U.S. population ages, primary and secondary clinical preventive services have become important issues for clinicians and policy makers. Few policy statements about prevention give guidance specific to older adults that consider how benefits and harms may be different in older adults than in younger adults. Decreasing life expectancy, increasing comorbidities, and competing causes of death may be leading to less benefit and potentially more harm from clinical preventive services in older adults. There are challenges in evaluation of the evidence in older adults and in applying the evidence to developing recommendations specific to older adults. A specific challenge is determining when the net balance of benefits and harms becomes negative;that is, the harms begin to outweigh the benefits. One important consideration is how quality of life affects the estimation of benefits and harms of clinical preventive services.