Most impactful factors on the health‐related quality of life of a geriatric population with cancer

Pisu, Maria; Azuero, Andres; Halilova, Karina I.; Williams, Courtney; Kenzik, Kelly; Kvale, Elizabeth; Williams, Grant R.; Meneses, Karen; Sullivan, Margaret M.; Yagnik, Supriya Kumar; Goertz, Hans-Peter; Rocque, Gabrielle Betty

doi:10.1002/cncr.31048

Cited by 42 publications

(39 citation statements)

References 38 publications

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“…Davidoff et al reported that out‐of‐pocket medical costs were higher among Medicare beneficiaries with cancer than without, and that this higher burden was at least partially explained by the presence of comorbidities and lack of supplemental insurance . In an analysis of factors that impact geriatric cancer survivors’ quality of life, Pisu et al found that the number of financial hardship events experienced was among the most important predictors of mental health …”

Section: Discussionmentioning

confidence: 99%

“…35 In an analysis of factors that impact geriatric cancer survivors' quality of life, Pisu et al found that the number of financial hardship events experienced was among the most important predictors of mental health. 36 Compared with white survivors, black survivors have experienced higher out-of-pocket costs, 37-39 a greater number of financial difficulties, 6 and more financial burden and distress. 38,40 They were also more likely to file for bankruptcy, experience cancer-related, 6 and other medical debt, 34 to be contacted by a collection agency and to borrow money to pay for medical debt.…”

Section: Discussionmentioning

confidence: 99%

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Financial burden among older, long‐term cancer survivors: Results from the LILAC study

et al. 2018

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BackgroundIncreasing attention is being paid to financial burdens of cancer survivorship, but little is known about the prevalence and predictors of these burdens in older, long‐term survivors.MethodsWe used data from 6012 participants diagnosed with cancer since enrolling in the Women's Health Initiative, and who participated in the Life and Longevity After Cancer (LILAC) ancillary study to estimate prevalence and identify predictors of financial burden. We used logistic regression to identify sociodemographic, socioeconomic, health‐ and cancer‐related factors associated with financial burden and backward selection to build a final multivariable model.ResultsAverage age at LILAC participation was 79 and 9.2 years had elapsed since cancer diagnosis. Overall, 6% experienced some form of financial burden, including having an insurance company refuse a claim (2.6%), being denied loans or insurance due to cancer history (2.2%), or experiencing significant indebtedness (1.8%, including facing large debts or bills or declaring bankruptcy). Eight predictors remained associated (P < 0.05) with financial burden in the fully‐adjusted model: younger age, shorter time since diagnosis, African‐American race, household income <$20 000/year, modified Charlson comorbidity score ≥2, receipt of chemotherapy, regional stage at diagnosis, and no private health insurance. Education, cancer site, social support, receipt of radiation, and receipt of hormone therapy were not associated with financial burden. Predictors differed between types of financial burden experienced and age at diagnosis (<65 vs 65+).ConclusionCancer‐related financial burden was rare in this population of older, female long‐term cancer survivors. The identification of several socioeconomic, health‐related and demographic predictors of financial burden may suggest targets of intervention to reduce financial burdens.PrecisFinancial burden was uncommon in older, female, long‐term survivors. Predictors of financial burden included age, race, income, comorbidities, time since diagnosis, stage, insurance, and receipt of chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Financial burden among older, long‐term cancer survivors: Results from the LILAC study

et al. 2018

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“…To the best of our knowledge, few studies to date have focused specifically on the role of social support in older adults with cancer, a population of participants who are likely to have more support needs than their younger counterparts and who are at increased risk of disruptions to their support systems. In previous studies, we found that physical and emotional support needs were among the most important factors associated with quality of life in older adults . Thus, a full characterization of the social support needs of older survivors, and evaluating the importance of meeting these needs, is warranted.…”

Section: Introductionmentioning

confidence: 96%

Unmet social support needs among older adults with cancer

Williams

Pisu

Rocque

et al. 2018

Cancer

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Background Adequate social support for older adults is necessary to maintain quality of life and reduce mortality and morbidity. However, little is known regarding the social support needs of older adults with cancer. The objective of the current study was to examine social support needs, specifically the unmet needs, among older adults with cancer. Methods Medicare beneficiaries (those aged ≥65 years) with cancer were identified from the University of Alabama at Birmingham Health System Cancer Community Network. Social support needs were assessed using a modified version of the Medical Outcomes Study Social Support Survey. The authors defined an “unmet need” if participants reported having some/a little/never availability of support and requiring support for that need. Results Of the 1460 participants in the current study, the average age was 74 years (standard deviation, 5.8 years). Approximately two‐thirds of participants (986 participants; 67.5%) reported having at least 1 social support need, with the highest needs noted in the emotional (49.5%) and physical (47.4%) support subdomains. Of those individuals with a support need, approximately 45% had at least 1 unmet need, with the greatest percentages noted in the medical (39%) and informational (36%) subdomains. Multivariable analyses demonstrated that participants who were nonwhite, were divorced or never married, or had a high symptom burden were at greatest risk of having unmet social support needs across subdomains. Conclusions In this population of older adults with cancer, the authors found high levels of unmet social support needs, particularly in the medical and informational support subdomains. Participants who were nonwhite, were divorced or never married, or had a high symptom burden were found to be at greatest risk of having unmet needs.

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“…In addition, older patients with cancer prioritize health‐related quality of life, and cancer treatment may affect a patient’s ability to engage with activities they enjoy by limiting physical and/or cognitive function . A telephone survey of 1457 older patients with cancer found that higher Charlson Comorbidity Index scores were associated with lower physical health‐related quality of life . Because older, medically complex patients with cancer already may be experiencing a compromised quality of life, they tend to make treatment decisions that emphasize health‐related quality of life over prolonged survival …”

Section: Discussionmentioning

confidence: 99%

“…35 A telephone survey of 1457 older patients with cancer found that higher Charlson Comorbidity Index scores were associated with lower physical health-related quality of life. 36 Because older, medically complex patients with cancer already may be experiencing a compromised quality of life, they tend to make treatment decisions that emphasize health-related quality of life over prolonged survival. 37 The National Comprehensive Cancer Network guidelines for oncology in older adults provide a total of 5 recommendations for patients with bladder cancer.…”

Section: Discussionmentioning

confidence: 99%

Association between treatment of superficial bladder cancer and 10‐year mortality in older adults with multiple chronic conditions

Garg

Young

O’Keeffe‐Rosetti

et al. 2018

Cancer

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Background Multiple chronic conditions (MCC) are common among older patients with cancer; however, the exclusion of these patients from clinical trials has resulted in scarce knowledge concerning outcomes, resulting in variations in treatment. Superficial bladder cancer (SBC) disproportionately affects older adults, yet to the authors’ knowledge few studies to date have examined whether treatment improves long‐term survival. In the current study, the authors evaluated the association between treatment of SBC and 10‐year mortality in medically complex older adults. Methods The authors identified 1800 older (aged ≥60 years) patients with SBC (American Joint Committee on Cancer stage ≤I) from 2 community‐based health systems who received treatment (bladder instillation and/or transurethral resection) or observation. Cox proportional hazards regression was performed adjusting for age, sex, race, health system, stage of disease/grade, and MCC (≥2 baseline chronic conditions). Propensity score analysis using stabilized inverse probability of treatment weights was used to compare 10‐year mortality in the 2 treatment groups with adjustment for covariates. Results Overall, 1485 patients (82.5%) and 315 patients (17.5%) received treatment and observation, respectively. In unweighted multivariable analysis, treatment was associated with a 30% reduction in death (adjusted hazard ratio [HR], 0.70; 95% confidence interval [95% CI], 0.58‐0.85 [P<.01]) and MCC with a 72% increase in death (adjusted HR, 1.72; 95% CI, 1.44‐2.05 [P<.01]). Weighted analysis with adjustment (doubly robust) also demonstrated a survival benefit for treatment (adjusted HR, 0.66; 95% CI, 0.52‐0.84 [P<.01]). Conclusions The results of the current study demonstrated a clinically meaningful association between cancer treatment and survival benefit in older, medically complex patients with SBC, even after adjustment for medical complexity. These data provide a foundation for future work aimed at personalizing the treatment guidance of older patients with cancer with MCC.

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Most impactful factors on the health‐related quality of life of a geriatric population with cancer

Cited by 42 publications

References 38 publications

Financial burden among older, long‐term cancer survivors: Results from the LILAC study

Financial burden among older, long‐term cancer survivors: Results from the LILAC study

Unmet social support needs among older adults with cancer

Association between treatment of superficial bladder cancer and 10‐year mortality in older adults with multiple chronic conditions

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