Treatment decision-making and quality of life versus length of life preferences of older patients with early stage cancer: A systematic review.

Abstract

Introduction: To fully consider the preferences and information needs of older adults, cancer treatment decision-making discussions should take a patient-centred approach. Some older patients may place more value on maintaining quality of life over the continuation of life-prolonging treatments, even when the cancer is early-stage and potentially curable. Decision support tools can play a role in facilitating discussions around treatment trade-offs. The objective of this review is to examine the literature on the treatment decision-making preferences of patients aged 70 and older with early-stage, potentially curable, cancer.

Materials and methods: MEDLINE OVID, CINAHAL, APA PsycINFO, Scopus, and Cochrane databases were systematically searched in January 2025. Published literature focusing on quality and length-of-life decision-making, and the use of decision support tools aimed towards older adults diagnosed with early-stage cancer, were included. Two authors performed full-text selection and quality appraisal. Data were synthesized according to themes, using the Framework Approach.

Results: From 1476 screened records, a total of 14 studies were included. Five key themes were identified: Information needs; Treatment preferences; Trade-offs (treatments, quality and length-of-life); Decision-making involvement; Available decision support interventions.

Discussion: Evidence suggests that older patients would benefit from receiving information about both quality and length-of-life when making cancer treatment decisions. Quality of life concerns including physical wellbeing, autonomy, and symptom burden were factors considered by patients. Decision support tools have the potential to assist in trade-off discussions, however, few have been developed to balance trade-offs between quality and length-of-life.

Registration: PROSPERO: CRD42025626454.