Impact of a structured multidisciplinary intervention on quality of life of older adults with advanced cancer

Abstract

Background Patients experience reductions in quality of life (QOL) while receiving cancer treatment and several approaches have been proposed to address QOL issues. In this project the QOL differences between older adult (age 65+) and younger adult (age 18-64) advanced cancer patients in response to a multidisciplinary intervention designed to improve QOL were examined. Methods This study was registered on ClinicalTrials.gov, NCT01360814. Newly diagnosed advanced cancer patients undergoing radiation therapy were randomized to active QOL intervention or control groups. Those in the intervention group received six multidisciplinary 90-minute sessions designed to address the five major domains of QOL. Outcomes measured at baseline and weeks 4, 27 and 52 included QOL (Linear Analogue Self Assessment [LASA], Functional Assessment of Cancer Therapy - General [FACT-G]) and mood (Profile of Mood States [POMS]). Kruskall-Wallis methodology was used to compare scores between older and younger adult patients randomized to the intervention. Results Of 131 patients in the larger randomized controlled study, we report data on 54 evaluable patients (16 older adults and 38 younger adults) randomized to the intervention. Older adult patients reported better overall QOL (LASA 74.4 vs 62.9, p=0.040), higher social well-being (FACT-G 91.1 vs 83.3, p=0.045), and fewer problems with anger (POMS Anger-Hostility 95.0 vs 86.4, p=0.028). Long-term benefits for older patients were seen in the Anger-Hostility scale at week 27 (92.2 vs 84.2, p=0.027) and week 52 (96.3 vs 85.9, p=0.005). Conclusions Older adult patients who received a multidisciplinary intervention to improve QOL while undergoing advanced cancer treatments benefitted differently in some QOL domains, compared to younger adult patients. Future studies can provide further insight on how to tailor QOL interventions for these age groups.

Effectiveness of palliative care interventions offering social support to people with life-limiting illness-A systematic review

“…After 1 year, participants over 65 ( n = 16) had longer lasting benefit than participants under 65 ( n = 38;Chock et al., )…”

“…Baseline social support might influence participant's experience of an intervention and its acceptability (Miller, Chibnall, Videen, & Duckro, ). Participant gender (Lapid et al., ) and age (Chock et al., ) may be relevant, but research is limited. The relevance of caregiver quality of life was highlighted as an important influence on patient quality of life (Clark et al., ; Rummans et al., ; Shahi et al., ).…”

“…Participant gender and age (Chock et al, 2013) may be relevant, but research is limited. The relevance of caregiver quality of life was highlighted as an important influence on patient quality of life (Clark et al, 2013;Rummans et al, 2006;Shahi et al, 2014).…”

“…FACT-SWB, POMS, caregiver QOL No significant difference found Gender differences in response at week 4 After 1 year, participants over 65 (n = 16) had longer lasting benefit than participants under 65 (n = 38; Chock et al, 2013) N/A POMS, IES Improvement in impact of events scale (p = −.03) Secondary analysis removed death-proximal participants (n = 10): statistical difference in mood disturbance (p = .02) and greater significance in IES Scale (p = .01)…”

Understanding the impact of pulmonary arterial hypertension on patients' and carers' lives

“…With regards to family caregivers and other family members, high levels of stress, which are associated with reduced caregiver QoL [31], and decreased mental health-related QoL [32] have been documented. Of note, in diseases such as advanced cancers and asthma, attempts to lower stress and improve QoL and emotional function by structured multidisciplinary interventions have shown promising results both for patients [33][34][35][36] and carers [34]. Considering these data and the findings of this survey, it is the opinion of the Pulmonary Hypertension Associations of Europe, the UK and the USA that a number of initiatives are required to ensure there is a comprehensive standard of care in the management of PAH.…”