Data_Sheet_1_Age- and gender-based social inequalities in palliative care for cancer patients: a systematic literature review.docx

ObjectivesCancer is a major public health problem worldwide, given its magnitude and growing burden, in addition to the repercussions on health and quality of life. Palliative care can play an important role improving quality of life and it is cost-effective, but some population groups may not benefit from it or benefit less based on age and gender inequalities. The aim of this systematic review was to analyze the available evidence on age- and gender-based social inequalities in access to and use of palliative care in cancer patients.
MethodsA systematic review was conducted following the PRISMA guidelines. An exhaustive literature research was performed in Pubmed, CINHAL and Embase until November 2022 and were not restricted by language or date of publication. Eligible studies were observational studies analyzing the access and use of palliative care in cancer patients.
ResultsFifty-three studies were included in the review. Forty-five analyzed age and 44 analyzed gender inequalities in relation to use of and access to palliative care. Our results show that older people receive poorer quality of care, worst symptom control and less preferences for palliative care. In relation to gender, women have a greater preference for the use of palliative care and generally have more access to basic and specialized palliative care services and palliative care facilities.
ConclusionThis review reveals difficulties for older persons and men for access to key elements of palliative care and highlights the need to tackle access barriers for the most vulnerable population groups. Innovative collaborative services based around patient, family and wider community are needed to ensure optimal care.

研究目的 癌症是全球范围内的重大公共卫生问题，鉴于其发病规模庞大且疾病负担持续攀升，同时还会对患者健康与生活质量造成诸多不良影响。姑息治疗（palliative care）在改善生活质量方面可发挥重要作用，且具备成本效益优势，但受年龄与性别不平等因素影响，部分人群可能无法从中获益或获益有限。本系统综述旨在分析现有关于癌症患者在姑息治疗获取与使用方面存在的年龄与性别相关社会不平等的证据。
研究方法 本研究遵循系统综述与元分析优先报告条目（PRISMA）指南开展系统综述。于2022年11月前在PubMed、CINHAL及Embase数据库中开展全面系统的文献检索，检索未对语言及发表时间设限。纳入标准为分析癌症患者姑息治疗获取与使用情况的观察性研究。
研究结果 本综述共纳入53项相关研究。其中45项研究分析了年龄相关不平等与姑息治疗使用、获取的关联，44项研究分析了性别相关不平等。研究结果显示，老年患者接受的护理质量更差、症状控制效果不佳，且对姑息治疗的偏好程度更低。在性别差异方面，女性对姑息治疗的使用意愿更强，通常也更易获得基础与专科姑息治疗服务及姑息治疗设施。
研究结论 本综述揭示了老年人群与男性群体在获取姑息治疗核心要素时面临的困境，并强调亟需针对最脆弱的人群群体破解准入障碍。亟需构建以患者、家属及更广泛社区为核心的创新协作型服务模式，以保障患者获得最优护理。