Journal of the National Cancer Institute Advance Access originally published online on July 28, 2009
JNCI Journal of the National Cancer Institute 2009 101(17):1206-1215; doi:10.1093/jnci/djp239
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© The Author 2009. Published by Oxford University Press.
ARTICLES |
Association of a Cancer Diagnosis With Vulnerability and Frailty in Older Medicare Beneficiaries
Affiliations of authors: James P. Wilmot Cancer Center (SGM), Department of Community and Preventive Medicine (YX, SGF), Department of Radiation Oncology (GRM), and Department of Medicine, Section of Geriatrics (WH), University of Rochester, Rochester, NY; Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL (WD); Department of Medicine, St Louis University, St Louis, MI (MR); Columbia University Medical Center, Columbia University, New York, NY (AN)
Correspondence to: Supriya Gupta Mohile, MD, MS, James P. Wilmot Cancer Center, University of Rochester, 601 Elmwood Ave, Box 704, Rochester, NY 14642 (e-mail: supriya_mohile{at}urmc.rochester.edu).
Background: Few studies have evaluated the independent effect of a cancer diagnosis on vulnerability and frailty, which have been associated with adverse health outcomes in older adults.
Methods: We used data in the 2003 Medicare Current Beneficiary Survey from a nationally representative sample of 12 480 community-dwelling elders. Multivariable logistic regression models were used to evaluate whether cancer was independently associated with vulnerability and frailty. Measures of vulnerability and frailty included disability, geriatric syndromes, self-rated health, and scores on two assessment tools for elderly cancer patients—the Vulnerable Elders Survey-13 (VES-13) and the Balducci frailty criteria. All statistical tests were two-sided.
Results: Diagnosis of a non-skin cancer was reported by 18.8% of the respondents. Compared with respondents without a cancer history, respondents with a personal history of cancer had a statistically significantly higher prevalence of limitations in activities of daily living (31.9% vs 26.9%), limitations in instrumental activities of daily living (49.5% vs 42.3%), geriatric syndromes (60.8% vs 53.9%), low self-rated health (27.4% vs 20.9%), score of 3 or higher on the VES-13 (45.8% vs 39.5%), and satisfying criteria for frailty as defined by Balducci (79.6% vs 73.4%) (P < .001 for all characteristics). After adjustment for confounders, a cancer diagnosis was found to be associated with low self-rated health (adjusted odds ratio [OR] = 1.46, 95% confidence interval [CI] = 1.30 to 1.64; relative risk [RR] = 1.33), limitations in activities of daily living (adjusted OR = 1.19, 95% CI = 1.06 to 1.33; RR = 1.13), limitations in instrumental activities of daily living (adjusted OR = 1.25, 95% CI = 1.13 to 1.38; RR = 1.13), a geriatric syndrome (adjusted OR = 1.27, 95% CI = 1.15 to 1.41; RR = 1.11), VES-13 score of 3 or higher (adjusted OR = 1.26, 95% CI = 1.13 to 1.41; RR = 1.14), and frailty (adjusted OR = 1.46, 95% CI = 1.29 to 1.65; RR = 1.09) as defined by Balducci criteria.
Conclusion: Diagnosis of a non-skin cancer was associated with increased levels of having disability, having geriatric syndromes, and meeting criteria for vulnerability and frailty.
| CONTEXT AND CAVEATS Prior knowledge Relatively few studies have evaluated the relationship between a cancer diagnosis in older adults and their vulnerability and frailty, which have been associated with adverse health outcomes in this population. Study design Cross-sectional study that used data from the 2003 Medicare Current Beneficiary Survey from a nationally representative sample of 12 480 community-dwelling elders. Statistical models were used to evaluate whether cancer was independently associated with vulnerability and frailty. Contribution Older adults with a diagnosis of a non-skin cancer were more likely to have more disabilities and geriatric syndromes and to meet criteria for vulnerability and frailty. Implications Assessment of underlying vulnerability and frailty should aid in the design of future clinical trials that are directed not only at improving survival but also at maintaining function, enhancing quality of life, and preventing geriatric syndromes. Limitations The cohort of cancer patients was heterogeneous. It could not be determined whether cancer or its treatment directly caused vulnerability or frailty in older patients. The number of patients with some cancer subtypes was small. Geriatric syndromes were self-reported. The assessment tools used in this study have not been validated in independent cohorts of older adults with cancer. From the Editors
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Manuscript received June 3, 2009; revised June 3, 2009; accepted June 26, 2009.
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