Abstract
Introduction
There is an increasing incidence of cancer in older people, but limited data on radiotherapy
uptake, and in particular, radiotherapy utilisation (RTU) rates. The RTU rate for
older adults with cancer may be lower than recommended due to lower tolerance for
radiotherapy as well as additional comorbidities, reduced life expectancy and travel
for treatment. Radiotherapy use must be aligned with best available, age-specific
evidence to ensure older adults with cancer receive optimal benefit without harms.
Materials and methods
A systematic review was conducted to synthesise the published data on the actual RTU
rate for patients with cancer as a function of age.
MEDLINE and EMBASE were systematically searched to identify relevant population-based
and hospital-based cohort studies on radiotherapy utilisation for all age groups,
published in English, from 1 January 1990 to 1 July 2020. We focused on the following
common cancers in older adults for which radiotherapy is recommended: breast, prostate,
lung, rectal cancer, glioblastoma multiforme (GBM), and cervical cancer. Age-specific
radiotherapy utilisation data were extracted and analysed as a narrative synthesis.
Results
From 2606 studies screened, 75 cohort and population-based studies were identified
with age-specific radiotherapy utilisation data. The total number of patients in the
75 studies was 4,792,138. The RTU rate decreased with increasing age for all tumour
sites analysed, except for patients receiving curative radiotherapy as definitive
treatment for prostate or cervical cancer. This reduction with increasing age was
demonstrated in both palliative and curative settings.
Discussion
There is a global reduction in radiotherapy utilisation with increasing age for most
tumour sites. The reduction in delivery of radiotherapy warrants further examination
and evidence-based guidelines specific to this population.
Keywords
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Article info
Publication history
Published online: October 20, 2022
Accepted:
October 5,
2022
Received in revised form:
September 16,
2022
Received:
June 15,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
