Barriers and enablers for older people at risk of and/or living with cancer to accessing timely cancer screening, diagnosis and treatment
Authors: Boyes Allison , Bryant Jamie , Hall Alix , Mansfield Elise 
Published: October 2022

•	Older adults have complex and unique needs that can influence how and when cancer is diagnosed, the types of treatment that are offered, how well treatment is tolerated and treatment outcomes. •	This Evidence Check review identified 41 studies that specifically addressed barriers and enablers to cancer screening, diagnosis and treatment among adults aged 65 years and older. •	Question 1: The main barriers for older people at risk of and/or living with cancer to access and participate in timely cancer screening relate to lack of knowledge, fear of cancer, negative beliefs about the consequences of cancer, and hygiene concerns in completing testing. The main enablers to participation in timely cancer screening include positive/helpful beliefs about screening, social influences that encourage participation and knowledge. •	Question 2: The main barriers for older people at risk of and/or living with cancer to access and/or seek timely cancer diagnosis relate to lack of knowledge of the signs and symptoms of cancer that are distinct from existing conditions and ageing, healthcare accessibility difficulties, perceived inadequate clinical response from healthcare providers, and harmful patient beliefs about risk factors and signs of cancer. The main enablers to accessing and/or seeking a timely cancer diagnosis include knowledge of the signs and symptoms of cancer, and support from family and friends that encourage help-seeking for symptoms. •	Question 3: The main barriers for older people at risk of and/or living with cancer in accessing and completing cancer treatment include discrimination against patients in the form of ageism, lack of knowledge, patient concern about the adverse effects of treatment, predominantly on their independence, healthcare accessibility difficulties including travel and financial burden, and patients’ caring responsibilities. The main enablers to accessing and completing cancer treatment are social support from peers in a similar situation, family and friends, the influence of healthcare providers, and involving patients in treatment decision making. •	Implications. The development of strategies to address the inequity of cancer outcomes in people aged 65 years and older in NSW should consider: ­	Increasing community members’ and patients’ knowledge and awareness by providing written information and decision support tools from a trusted source ­	Reducing travel and financial burden by widely disseminating information about existing support schemes and expanding remote patient monitoring and telehealth ­	Improving social support by promoting peer support, and building the support capacity of family carers ­	Addressing ageism by supporting patients in decision making, and disseminating education initiatives about geriatric oncology to healthcare providers ­	Providing interdisciplinary geriatric oncology care by including a geriatrician as part of multidisciplinary teams and/or expanding geriatric oncology clinics.