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Table 1 Results and characteristics of the included studies

From: Quality of life among cancer inpatients 80 years and older: a systematic review

Nr Author, country Aim Design and setting Participants and control group QoL instruments used Results Authors' conclusions CASP scorea
¤Number of cancer inpatients older than 80 years of age in the study sample not specified Subgroup estimates of QoL in inpatients more than 80 years of age not stated
1 Alaloul et al., USA [35] To identify a relationship between patient satisfaction with the hospital experience and HRQoL and to determine the predictors of each variable in cancer survivors A descriptive, cross-sectional design
Two acute cancer care units
50 patients with cancer in two adult oncology units in an academic health sciences center
Age range 18–80 years or older (two patients 80 years or older)
QOL-CS (cancer survivor) Patients with public insurance, diagnosed for 6–10 years and diagnosed for 11 years or longer had lower QoL-CS scores. Patient demographics were related to patient satisfaction and QoL Physical well- being, social well- being and time since cancer was related to patient satisfaction and QoL ***
2 Leak Bryant et al., USA [34] Examine symptoms, mobility and function and QoL in adults with acute leukemia 7-day prospective study
Hospital
49 patients with a mean age of 51.6 years (SD 15.8, range 21–88)¤ FACT-Leuk,
v. 5.0
PROMIS Global
Health
Global mental health and pain intensity did not change significantly. Global physical health significantly improved. Fatigue, anxiety, depression and sleep disturbance decreased significantly. QoL increased significantly. Median LOS 33.2 days (SD 10, range 12–63) The significant decrease in anxiety and fatigue during hospitalization may be attributable to understanding of the disease process, familiarity with the staff and ability to communicate concerns ****
3 El-Jawahri et al., USA [24] To assess and compare the QoL, fatigue and mood of older patients with acute myelogenous leukemia (AML) receiving intensive and non-intensive chemotherapy Prospective longitudinal cohort study
Hospital
100 patients > 60 years with a new diagnosis of AML, median age 71 years (range 60–100)¤ FACT-Leuk
FACT-
Fatigue
Older patients with AML experience improvements in their QoL and anxiety while undergoing treatment. Patients receiving intensive and non-intensive chemotherapy have similar QoL and mood trajectories The lived experience of older patients receiving intensive chemotherapy was similar to those receiving non-intensive therapy with respect to QoL, fatigue and symptoms of depression and anxiety ****
4 Gu et al., China
[32]
To examine the prevalence and correlates of depression and its impact on HRQoL in lung cancer patients Prevalence study Hospital 148 patients, mean age 64.8 years (SD 11.5, range 20–99)¤ WHOQOL-
BREF
The prevalence of depression was 43%: men, 39%, women, 50%. Depressed patients had significantly poorer HRQoL than non-depressed patients in terms of all four domains; physical (P < 0.001), psychological (P < 0.001), social (P < 0.001) and environmental ( P < 0.001) Depression is prevalent in inpatients with lung cancer and independently associated with poor HRQoL ***
5 Holloway, USA
[25]
Assess the association between preoperative QoL and postoperative LOS in colorectal cancer patients after surgical therapy Prospective cohort study, 1999–2002
Hospital
70 patients
Median age 65 years (range 51 -85)¤
FACT-C Poorer pretreatment FACT-C scores (95% CI 1.1–15.6) were significantly associated with increased LOS. Median LOS for the entire group was 6 days (range 3–25). Pretreatment HRQoL scores as measured by FACT-C may benefit in predicting LOS Such information may be an important and currently neglected means of risk-adjusting populations undergoing surgery for colorectal cancer for this outcome ***
6 Ishihara, Japan
[31]
Evaluate the long-term QoL of patients who underwent total gastrectomy for cancer Prospective, cross-sectional survey
Hospital
51 patients with stomatic cancer, TNM stages I, II or III a
Age range 39–82 years¤
EORTC-QOL-
C30
Comprehensive QOL was good in 20, slightly poor in 17 and poor in 12 (41%) of the 29 patients with good ADL. Dumping symptoms developed in 13 patients (26%), 2 of whom had severe condition. Clear decreases in physical and mental strength (spiritual energy) were reported by 10 and 8 patients It is important to evaluate surgical results also with regard to the patients' long-term postoperative QoL **
7 Jasinska et al.,
Poland [27]
Assessment of change of QoL in hospitalized terminally ill palliative cancer patients Prospective cohort
2007–2009
[25] Hospital
41 inpatients, mean age 68 years (range
46–85)¤
EORTC QLQ-
C15—PAL
Overall QoL was in correlation with the type of diagnosed carcinoma. During the end-of-life care performed in the palliative care unit, the subjective QoL and emotional functioning in patients did not worsen, and in some patients the above parameters improved The effectiveness of palliative care relating to overall QoL did not differ significantly among patients with various types of tumors ***
8 Jia et al., China [20] Investigate cancer-related depression and the relationship between symptoms of depression and QoL Prevalence study Hospital 262 inpatients with cancer of the digestive system, 50 pancreatic, 60 liver, 50 esophageal, 50 gastric and 52 colorectal cancer patients Four age strata from 20 to 85 years¤ EORTC-QLQ-
C30
EORTC-QLQ-PAN-26
The incidence of depression among pancreatic cancer patients was significantly higher than among other types of digestive cancer. Compared with other groups with depression, the QoL of pancreatic cancer patients in each functioning scale was significantly worse, while the symptoms of fatigue and pain were significantly more severe Depression significantly lowers QoL in pancreatic cancer patients ****
9 Jocham et al., Netherlands [39] QoL assessment of terminally ill patients with cancer, the changes in time, and differences between the groups Prospective cohort and longitudinal (7 days) 10 palliative home care services, one palliative care unit in a general hospital Stratified random sample of 121 cancer@@patients, 64 inpatients, mean age 64.4 years (range 35–94) 57 home care patients, mean age 61,7 years¤ EORTC- QLQ C30 The hospital group showed a statistically significant and clinically relevant decrease in nausea and vomiting, pain and dyspnea. The home care group had statistically significant improvements in the domains of QoL function: cognitive, physical, role, emotional, social EORTC QLQ-C30 can be a useful measure for the QoL of German cancer patients under palliative care symptom control and were sensitive to changes over time ***
10 Nafteux et al., Belgium [28] Identify preoperative QoL factors predicting prolonged hospital stay after esophagectomy caused by cancer 12 months prospective cohort Hospital 455 at baseline 330 after 2 years Mean age 63 (range 34–88)¤ EORTC-QLQ- C30 EORTC-QLQ-OES-18 Low QoL predicts LOS. Prognostic factors, LOS (> 10 days): medical HR, 6.2 (3.62–10.56, surgical HR 2.79 (1.70 -4.59), morbidity, readmittance to intensive care unit HR 33.82 (4.55–251.21); poor physical functioning HR 1.89 (1.14–3.14) Better perception of preoperative physical functioning might have a beneficial effect on LOS. Early discharge correlates with improved postoperative HRQoL outcomes ****
11 Peters & Sellick, Australia [36] To report symptom experience, physical, mental health, perceived control of the effects of cancer and QoL and the predictors of QoL of terminally ill cancer patients Comparative cohort study Hospital and home-based 32 inpatients and 26 home-based, mean age 67.8 years (range 40–92)¤ EORTC QLQ- C30 [4] Patients receiving home-based services had statistically significantly less symptom severity and distress, lower depression scores and better physical health and QoL than those receiving inpatient care. Better global physical health, greater control over the effects of cancer and lower depression scores were statistically significant predictors of higher QoL Early detection and management of physical and mental symptoms and strategies that will empower patients to have a greater sense of control over their illness and treatment may impact QoL ****
12 Shinozaki et al., Japan [40] Investigate QoL and functional status of terminally ill head and neck cancer patients Multicenter, prospective, observational study Hospital 100 patients, 72 were observed until death Median age 69 years (range 37–94)¤ EORTC QLQ- C15-PAL No significant difference in QoL score between baseline and week 3. The route of nutritional intake (nasogastric tube versus percutaneous gastric tube) predicted the length of hospital stay (64 versus 21 days, P = 0.04) and may play a role for QoL Feeding tube type could have the most impact on QoL ****
13 Stromgren et al., Denmark [29] To study disease-related and treatment-related HRQoL, functional capacity and symptoms of patients with cancer 5-week prospective cross-sectional survey Hospital 124 patients, mean age 59 years (range 21–88)¤ EORTC QLQ C30 WHO PS HRQoL, role and social functioning were more severely impaired in hematology patients than in cancer patients, whereas pain and constipation were worse for cancer patients than for hematology patients Patients (hematology and cancer) had pronounced symptoms and low QoL ****
14 Torvik et al., Norway [30] Examine differences in pain, pain management, satisfaction with pain management, QoL and pain interference between middle-aged and older patients with bone metastases Prevalence study Hospital 79 patients, 39 =  > 65 years, Mean age 76, Range (66—88)¤ Global QoL (single item) Older patients, higher scores for "worst pain" (P = 0.04), "pain severity intensity" (P = 0.03) but received strong opioids for their cancer pain significantly less often than middle-aged patients (P = 0.02). Linear association between increasing age and decreasing pain (P = 0.002) These results indicate that more focus is needed on pain management and QoL in older cancer patients with bone metastases ***
15 Van der Walde et al., USA [33] Investigate geriatric assessment as a predictor of tolerance, QoL and outcomes in older patients with head and neck cancer and lung cancer receiving radiation therapy Prospective cohort study
Hospital
46 patients, mean age 72.5 Range (6592) 13% of sample was aged 80 + [6]¤ EORTC QLQ- C30 Patients with 1-ADL dysfunction at baseline were more likely to have reduced HRQoL on role and social function after radiation therapy. Patients with dysfunction had lower baseline HRQoL scores Pretreatment dysfunction was associated with continued decline and lack of recovery of HRQoL in this patient population ****
16 Wittmann-Vieira & Goldim, Brazil [37] Evaluate the decision-making process and QoL of adult cancer patients Cross-sectional Inpatients in a palliative unit 89 patients, mean age 53 years, range (25—85)¤ WHOQOL- OLD WHOQOL- BREF In the domains of WHOQOL-OLD, the social participation had the lowest mean and intimacy had the best. In terms of application of the domains of the WHOQOL-BREF instrument, the physical domain had the lowest mean, while the environment had the best performance Patients demonstrated satisfaction with the capacity to establish social relationships, personal and intimate, when answering WHOQOL-OLD and WHOQOL-BREF, even while hospitalized ***
17 Lee et al., South Korea. [38] Explore the QoL and performance status as prognostic indicators of survival Retrospective cohort study Inpatients in palliative care 162 inpatients with advanced cancer, age range 40–86 years¤ EORTC-QLQ- C15 PAL ECOG Physician-reported PPS significantly predicted survival (HR 0.493; P < 0.001). From the EORTC QLQ-C15-PAL, patient-reported physical functioning predicted survival (HR = 0.65; P < 0.001). the other six domains of EORTC QLQ-C15-PAL (global health status, emotional functioning, fatigue, nausea and vomiting, appetite loss and constipation) were significantly related to survival after adjustment QLQ is useful even for patients in their final month of life. Cancer anorexia-cachexia syndrome-related symptoms may be independent prognostic symptoms ***
  1. a Critical assessment of the studies was graded according to different design specific CASP checklists: *25% of criteria met; **50% of criteria met; ***75% of criteria met; ****100% of criteria met [26]
  2. ¤Number of cancer inpatients older than 80 years of age in study sample not specified
  3. Subgroup estimates of QoL in inpatients older than 80 years of age not stated.
  4. ADL: activities of daily living; EORTC: European Organization for Research and Treatment of Cancer; FACT-Leuk: Functional Assessment of Cancer Therapy- Leukemia; FACT-C: Functional Assessment of Cancer Therapy - colorectal cancer; FACT-Fatigue: Functional Assessment of Cancer Therapy - fatigue; HRQoL: health-related quality of life LOS: length of stay; OES-18: Oesophageal cancer module, 18 items; PPS: Palliative Performance Scale; PROMIS: Patient-Reported Outcomes Measurement Information System; QoL: quality of life; QLQ-C15-PAL: Quality of Life Questionnaire Core 15 for Palliative Care; QlQ-C30-PAL: Quality of Life Questionnaire Core 30 for Palliative Care; QOL-CS: Quality of Life Patient Cancer Survivor version; QLQ-PAN-26: Quality of Life Questionnaire Core 26 for Pancreatic Cancer; WHOQOL-BREF: World Health Organization Quality of Life Questionnaire, brief version; WHOQOL-OLD: World Health Organization Quality of Life Questionnaire in old people; WHO PS: World Health Organization Performance Scale