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

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.