Changes in quality of life throughout the illness trajectory of older adults with cancer: A systematic review

Abstract

Background Older adults with cancer often experience frailty and comorbidities, potentially impacting their quality of life. Knowledge on quality-of-life changes throughout the cancer trajectory is important to set feasible expectations in interventions or trials. Aim This systematic review synthesizes existing knowledge on quality-of-life changes in older adults with cancer throughout their illness trajectory and explores potential individual, relational, community, and societal factors associated with these changes. Method We systematically searched PubMed, Embase, and PsycINFO. We synthesized characteristics and outcomes of all studies reporting on quality-of-life or well-being changes in people aged 65+ with cancer. We used Bronfenbrenner's Social Ecological Model to categorize associated factors. We followed PRISMA guidelines and registered in PROSPERO (CRD42024566815). Results We included 22 studies. Studies varied in characteristics of the cohorts and timing of the measurements and were often lacking clear quality-of-life conceptualizations. All studies used a quantitative design, except 1 mixed-methods study. Eight of 9 studies with follow-up moments of 12 months or more reported stable quality-of-life scores. All 3 studies examining the last year of life found quality-of-life declines. Five other studies reported a decline during treatment; in 4 studies followed by an increase. Comorbidities, older age, and mobility problems were most frequently associated with declining quality of life. Relational, community, and societal level factors were rarely studied. Conclusion Despite the methodological heterogeneity between studies, we identified trends in quality-of-life changes across the illness trajectories of older adults with cancer, particularly declining trends during treatment and end-of-life periods and stable trends in long-term follow-up.