Transcript Older cancer patients

KLIMOP: a cohort study on the
wellbeing of older cancer patients
Laura Deckx
Liesbeth Daniels, Katherine Nelissen, Piet Stinissen, Paul Bulens, Loes Linsen,
Jean-Luc Rummens, Doris van Abbema, Franchette van den Berkmortel, Hans
Wildiers, Vivianne C. Tjan-Heijnen, Marjan van den Akker, Frank Buntinx
Klimop
• Klimop was conceptualised by Prof. Buntinx and Dr. Bulens after
a study performed by LIKAS in 2007 among stakeholders
• “Cancer in Limburg: Challenges and strategic options
for a coordinated approach “
• This study showed that the challenges in cancer care will be:
– The psychosocial aspects of cancer care
– Scientific research for older cancer patients
Survival: quantity or quality?
• Survival: quantity
– Survival of cancer patients increases
– Not for older cancer patients: EUROCARE project
(Quaglia 2009)
• Survival: quality
– The fear to loose autonomy > the fear to die
(Jolly 2006)
– Macmillan Listening Study: To study the impact of cancer on
everyday life was defined as the top priority area for cancer
research (Okamoto 2011)
Klimop-study
To assess the impact of cancer, ageing and their interaction on
subsequent wellbeing of older cancer patients
Comorbidity
Functional
status
Depression
Quality of life
Inclusion (January 2011)
Baseline
6 months
1 year
Younger cancer patients
168
84
30
Older cancer patients
100
44
7
Older patients without cancer
157
84
25
Total interviewed
425
212
62
Lost to follow-up
/
40
4
Deceased
/
14
3
...
Comorbidity
Functional status
Depression
Quality of life
Comorbidity
• Comorbidity: the co-occurence of different diseases
• Comorbidity is an enormous problem (Marengoni 2011)
– Highly prevalent (55% - 98%)
– Cause of disability, functional impairment, low Qol, high
health care costs
– Survival
Comorbidity
Number of chronic diseases
(additional to cancer)
30
25
20
% 15
10
5
0
0
1
Cancer patients (60+)
2
3
≥4
Non-cancer patients (60+)
Guidelines to for the treatment of cancer patients with comorbidity are lacking!
(Signaleringscommissie Kanker van KWF Kankerbestrijding 2011)
Comorbidity
Functional status
Depression
Quality of life
Functional status
• Maintenance of independence is very important
• Associated with survival
• Cancer patients have more functional problems
(Hewitt 2003, Keating 2005)
• Little prospective studies that investigate the risk factors for
functional decline in older cancer patients
→ Cave! Selection of participants
Functional status* :
Baseline ~ 6 months
Worse
Idem
Better
Baseline
N (%)
N (%)
N (%)
Impaired
16 (10%)
39 (46%)
37 (44%)
8 (10%)
Not impaired
152 (90%)
12 (27%)
21 (48%)
11 (25%)
17 (20%)
53 (63%)
14 (17%)
Younger cancer patients
Older cancer patients
Impaired
23 (23%)
Not impaired
77 (77%)
Older patients without cancer
Impaired
45 (19%)
Not impaired
112 (71%)
*Functional status (ADL en IADL): Computed as described by Kellen et al. 2010
Baseline
Functional status* ~ Loneliness
Impaired
Not
impaired
N
N
OR
95%
CI
2.2
0.6 – 7.8
4.4
1.4 – 14.0
1.2
0.6 – 2.5
Younger cancer patients
Lonely
27 (18%)
4
23
Not lonely
124 (82%)
9
115
Lonely
26 (35%)
10
16
Not lonely
48 (65%)
6
42
Lonely
56 (38%)
17
39
Not lonely
91 (62%)
24
67
Older cancer patients
Older patients without cancer
*Functional status (ADL en IADL): Computed as described by Kellen et al. 2010
Comorbidity
Functional status
Depression
Quality of life
Depression
• Depression is important:
– Leading cause of disability worldwide
– Commonly coexists
– Predicts overall survival (Kanesvaran 2011 JCO)
• Depression decreased – overall survival increased!
(Giese-Davis 2011 JCO)
• Results are inconclusive
Depression:
Baseline ~ 6 months
Worse
(>10%)
Idem
Better
(>10%)
Baseline
N (%)
N (%)
N (%)
12 (8%)
11 (15%)
44 (59%)
20 (27%)
5 (18%)
18 (64%)
5 (18%)
8 (11%)
51 (71%)
13 (18%)
Younger cancer patients
Depressive feelings
No depressive feelings
139 (92%)
Older cancer patients
Depressive feelings
11 (14%)
No depressive feelings
66 (86%)
Older patients without cancer
Depressive feelings
18 (12%)
No depressive feelings
133 (88%)
Baseline
Depression ~ Loneliness
GDS-15
≥5
GDS-15
<5
N
N
OR
95%
CI
4.8
1.3 – 17.1
8.6
1.6 – 45.2
9.9
2.7 – 36.4
Younger cancer patients
Lonely
25 (17%)
5
20
Not lonely
120 (83%)
6
114
Lonely
25 (35%)
7
18
Not lonely
46 (65%)
2
44
Lonely
55 (38%)
14
41
Not lonely
90 (62%)
3
87
Older cancer patients
Older patients without cancer
Comorbidity
Functional status
Depression
Quality of life
Quality of life
• What is the impact of cancer, cancer treatment, ageing and
their interaction on Qol?
– Results are inconclusive
• Methodological shortcomings (Joly 2007)
– Cross-sectional
– Presentation of mean values!
– Prospective but Qol measured only once
– Selection of patients
Global Qol:
Baseline ~ 6 months
Worse
(>10%)
Idem
Better
(>10%)
N (%)
N (%)
N (%)
31 (38%)
15 (19%)
35 (43%)
18 (55%)
8 (24%)
7 (21%)
17 (21%)
35(43%)
30 (37%)
Younger cancer patients
Global Qol
Older cancer patients
Global Qol
Older patients without cancer
Global Qol
Comorbidity
Functional status
Depression
Quality of life
Wellbeing
Little is known about the
Comorbidity
Functional
status
interaction between the
co-occurrence of
- Comorbidity
Depression
Quality of
life
- Functional impairment
- Geriatric syndromes
(Koroukian 2011 JCO)
Preliminary conclusions
• Results are preliminary and cross-sectional! The longer the duration
of the study, the more valuable the results will be
• Loneliness and depression are frequent and important factors that
can be influenced
• Guidelines for care of cancer patients with multimorbidity are
needed, taking into account:
– Co-morbidity/functional impairment/…
– Consequences of cancer treatment
– Collaboration between different disciplines in primary and secondary care
Take home message
• Be critical!
– Was the study population appropriate?
– Cross-sectional design versus prospective design?
• Older cancer patients
– Heterogeneous group
– Specific health care needs
• Quality rather than quantity of survival
– Which factors determine maintenance or decline of wellbeing?
“Knowing is not enough; we must apply. Willing is not enough; we must do.”
Goethe
KLIMOP is funded by VLK, the Flemisch League against Cancer and Interreg IV
cross-border region Flanders – the Netherlands
Contact:
[email protected]
[email protected]
[email protected]
www.ouderenenkanker.be
Deckx L, Van Abbema D, Nelissen K, Daniels L, Stinissen P, Bulens P, Linsen L, Rummens JL, Van den Berkmortel F, Robaeys G, De Jonge E, Houben B,
Pat K, Walgraeve D, Spaas L, Verheezen J, Verniest T, Goegebuer A, Wildiers H, Tjan-Heijnen V, Buntinx F, Van den Akker M. Study protocol of
KLIMOP: a cohort study on the wellbeing of older cancer patients in Belgium and the Netherlands. BMC Publ Health 2011; 11: 825