Older cancer survivors experienced greater declines in physical functioning and an increased risk for depression than age-matched healthy adults, according to the results of a prospective study.
Treating physicians should prepare older adults diagnosed with cancer for changes in their level of function, and should conduct interventions to curb actionable declines when appropriate, according to the researchers.
“The impact of cancer diagnoses and cancer therapies on physical function and psychological state is something on the minds of both patients and clinicians,” Arti Hurria, MD, director of the Cancer and Aging Research Program at City of Hope Comprehensive Cancer Center and HemOnc Today’s geriatric oncology section editor, told HemOnc Today. “These studies are critical to add to that information, and the literature will continue to broaden and evolve.”
Many older cancer survivors experience age-related health issues, including functional decline, urinary incontinence and arthritis. The degree to which cancer creates or worsens these conditions remains unknown.
“Often times it can be difficult for researchers to tease apart the effects of cancer and aging among those who are diagnosed with cancer: what changes are due to ‘normal aging’ and what changes are a direct effect of cancer and its treatment,” Corinne Leach, PhD, MPH, MS, director of cancer and aging research at the American Cancer Society, told HemOnc Today.
Hurria, Leach and colleagues used the SEER database linked with data from the Medicare Health Outcomes Survey to evaluate a cohort of 921 survivors of breast, colorectal, prostate or lung cancers (median age, 73.6 years; 57.5% men; 79.8% non-Hispanic white). The analysis also included a matched control population of 4,605 older adults without cancer.
The researchers used the Physical Component Summary (PCS) of the Short Form Health Survey to compare changes in physical functioning, activities of daily living, age-related conditions, and the exacerbation of preexisting conditions among cancer survivors compared with controls.
All cancer groups exhibited significant declines in physical functioning (adjusted P < .05) that exceeded the minimally important difference in mean physical function over time. Survivors of lung cancer had the greatest mean PCS changes between baseline and follow-up (controls, –1.53 [standard error, 0.14]; survivors, –6.72 [standard error, 0.94]).
Survivors of lung cancer had the most pervasive changes, especially with regard to bathing (12% vs. 22%), dressing (8% vs. 19%), eating (5% vs. 14%), and getting in and out of chairs (21% vs. 34%).
Survivors of colorectal cancer had significant changes with regard to dressing over time (11% vs. 18%).
Cancer survivors had a greater risk for depression than controls. Particularly, higher risks for major depressive disorder occurred among survivors of colorectal cancer (OR = 1.75; 95% CI, 1.21-2.52) and prostate cancer (OR = 1.47; 95% CI, 1.08-1.98).
Prostate cancer survivors had a higher risk for urinary incontinence (OR = 3.28; 95% CI, 2.53-4.25); reports of urinary incontinence did not increase from baselines in other cancer subtypes.
Having cancer did not significantly raise the risk for developing arthritis of the hand or the hip, vision problems or hearing problems. It also did not significantly worsen the severity of existing arthritis or foot neuropathy.
“Unfortunately, most intervention trials exclude older adults and those with multiple chronic conditions from the development and testing process,” Leach said. “More interventions are needed in the future that include older survivors and those with complex health profiles.”
The researchers acknowledged limitations of their study, including the reliance on self-reported data and the inability to include patients with stage IIIB lung cancer, who are usually treated only with palliative care.
They also noted that the older adults included in the population are healthier than average Medicare fee-for-service beneficiaries, which may have led to an underestimation of the extent to which cancer affects activities of daily living.
Overall, proper medical assessment of older adults with cancer is crucial, Leach said.
“A comprehensive geriatric assessment is an essential tool used to screen older adults for physical and cognitive impairments as well as geriatric syndromes, nutritional adequacy and overall frailty,” Leach said. “Having the comprehensive geriatric assessment incorporated into routine oncology practice will identify patients at high risk for chemotherapy toxicities, falls, and mortality in a timely manner.”
“Awareness is our first defense,” she said. “In particular, we should ask patients whether they are experiencing symptoms of depression, or if they are noticing declines in their own functioning. There is a lot that can be done to help patients feel better and live healthier lives.” – by Cameron Kelsall
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Corinne Leach, PhD, MPH, MS, can be reached at email@example.com.
Hurria reports research funding from Celgene and GlaxoSmithKline, as well as consultant roles with Boehringer Ingelheim, Carevive Systems, GTx Inc. and Sanofi. The other researchers report no relevant financial disclosures.