title: Referral of elderly cancer patients to specialists: action proposals for general practitioners.
abstract: BACKGROUND
  Many studies have identified advanced age as a barrier to accessing specialized oncological care.
  
  
  OBJECTIVE
  To identify elements from the literature influencing general practitioners (GPs) in their decisions to refer elderly patients with cancer to oncology teams, and propose focused actions to improve referral processes.
  
  
  METHODS
  Eligible articles published up to July 2010 identifying factors associated with referral decisions for elderly cancer patients were selected. A quality assessment of each article was performed. All factors identified were considered for possible interventions classified by the Effective Practice and Organisation of Care (EPOC) taxonomy and development of recommendations for referral of elderly patients.
  
  
  RESULTS
  Thirty eligible articles were found with only 18 articles specifically exploring factors influencing physicians in the referral of their patients with cancer. Twelve focused on delay to treatment and only two uniquely on elderly patients. Patient age was the main factor associated with referral decisions, but this factor can influence GP's differently depending on the type of cancer. The small size of these studies, heterogeneity of study populations, and diversity of outcome measures used meant that compilation of guidelines based on high-quality evidence was not possible. However, organizational factors hindering decisions to refer are identified and highlighted as crucial for inclusion in intervention programs, specifically to reach GPs in smaller locations or with less experience in collaborating with specialists. For patient-related factors, professional and organizational interventions are necessary, aimed at both GPs and patients to update knowledge of the non-linear relationship between chronological age and a patient's ability to tolerate treatment.
  
  
  CONCLUSIONS
  First and foremost, this article highlights the scarcity of literature specific to elderly patients with cancer. It also identifies the public health need for better knowledge of the factors for referral of elderly patients. Focussed action proposals are presented to improve knowledge and consequently, optimize the referral process.
authors.affiliation: Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France; Inserm U897, CIC-EC7, Bordeaux, France.
authors.forename: Fleur
authors.initials: F
authors.lastname: Delva
authors.forename: Pierre
authors.initials: P
authors.lastname: Soubeyran
authors.forename: Muriel
authors.initials: M
authors.lastname: Rainfray
authors.forename: Simone
authors.initials: S
authors.lastname: Mathoulin-Pélissier
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D058005:General Practitioners / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data*; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*