Factors influencing the symptom appraisal and help seeking of older adults with possible cancer: a mixed methods systematic review

Background The burden of cancer falls predominantly on older adults. Prompt presentation to primary care with cancer symptoms could result in an earlier diagnosis. However patient symptom appraisal and help seeking decisions involving cancer symptoms are complex and may be further complicated in older adults. Aim To explore the effect of older age on patients’ appraisal of symptoms that may indicate cancer and their decision to seek help for these symptoms. Design Mixed methods systematic review Method Medline, Embase, CINAHL, PsycInfo, Cochrane Library, Web of Science Core Collection, ASSIA, ISRCTN registry and NICE were searched for studies on the symptom appraisal and help seeking decisions relating to cancer symptoms by adults aged 65 and over. Studies were analysed using thematic synthesis and according to the Synthesis Without Meta-Analysis (SWiM) guidelines Results Eighty studies were included in the review with a total of 324,995 participants. The studies suggested a possible association between increasing age and a prolonged symptom appraisal interval. Factors such as reduced knowledge of cancer symptoms and differences in symptom interpretation may contribute to this prolonged interval. In contrast, we found a possible association between increasing age and prompt help-seeking. Themes affecting help seeking in older adults included the influence of family and carers, competing priorities, fear, embarrassment, fatalism, co-morbidities, a desire to avoid doctors, a perceived need to not waste doctor’s time and patient self-management of symptoms. Conclusions This review suggests that increasing age is associated with delayed cancer symptom appraisal. When symptoms are recognised as potentially serious, increasing age was associated with prompt help seeking although factors such as fear of wasting a doctor’s time could prolong this. As a result of this review, policy makers, charities and information from GPs should aim to ensure older adults are able to recognise potential symptoms of cancer and can seek help promptly.