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Functional Impairments and Quality of Life in Older Adults With Upper Gastrointestinal Cancers

Published:December 23, 2020DOI:https://doi.org/10.1016/j.jss.2020.11.057

      Abstract

      Background

      Functional impairments (measured by activities of daily living [ADLs]) and health-related quality of life (HRQOL) may complicate outcomes in older adults diagnosed with cancer. In this retrospective cohort analysis, we characterized ADLs and HRQOL in adults older than 65 y with upper gastrointestinal (UGI) cancers and evaluated for an association to cancer-specific survival.

      Materials and methods

      Patients with UGI cancers aged 65 y or older were selected from the Surveillance, Epidemiology and End Results and the Medicare Health Outcomes Survey–linked database. Demographics, comorbidities, stage, ADLs, and HRQOL were summarized by patients managed with and without surgery. Because of the wide variety of cancers, we subdivided patients into cohorts of esophagogastric [EG; n = 88] or hepatobiliary/pancreatic [n = 68]. Cancer-specific survival curves were modeled for changes in ADL and HRQOL scores after diagnosis. Risk factors for cancer-specific survival were assessed with hazard ratios (HRs) and adjusted for demographics, stage, comorbidities, and disease cohorts.

      Results

      HRQOL scores declined after diagnosis, with a sharper decline in nonsurgery patients. On multivariate analysis, inability to perform specific ADLs was associated with worse survival in multiple cohorts: hepatobiliary/pancreatic nonsurgery patients unable to eat (HR 3.3 95% confidence interval (CI) 1.7-6.5); all patients with EG unable to use the toilet (HR 3.3 95% CI 1.5-7.9); EG nonsurgery cohort unable to dress or use the toilet (dress HR 14.1 95% CI 4.0-49.0; toilet HR 4.7 95% CI 1.8-12.3).

      Conclusions

      Older survivors with UGI cancers report declines in HRQOL, especially those not undergoing surgery. The ability to perform ADLs may be linked to survival in this population.

      Keywords

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      References

        • Toossi M.
        Labor force projections to 2022: the labor force participation rate continues to fall.
        U.S. Bureau of Labor Statistics, 2013 (Available at:)
        • Pallis A.G.
        • Fortpied C.
        • Wedding U.
        • et al.
        EORTC elderly task force position paper: approach to the older cancer patient.
        Eur J Cancer. 2010; 46: 1502-1513
        • Span P.
        The Elderly are Getting Complex surgeries. Often it Doesn’t End well.
        The New York Times, New York City, NY2019
        • van Abbema D.
        • van Vuuren A.
        • van den Berkmortel F.
        • et al.
        Functional status decline in older patients with breast and colorectal cancer after cancer treatment: a prospective cohort study.
        J Geriatr Oncol. 2017; 8: 176-184
        • Brinson Z.
        • Tang V.L.
        • Finlayson E.
        Postoperative functional outcomes in older adults.
        Curr Surg Rep. 2016; 4: 21
        • Kent E.E.
        • Malinoff R.
        • Rozjabek H.M.
        • et al.
        Revisiting the surveillance epidemiology and end results cancer registry and medicare health outcomes survey (SEER-MHOS) linked data resource for patient-reported outcomes research in older adults with cancer.
        J Am Geriatr Soc. 2016; 64: 186-192
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gøtzsche P.C.
        • Vandenbroucke J.P.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        J Clin Epidemiol. 2008; 61: 344-349
        • SEER-Medicare Health Outcomes Survey (SEER-MHOS)
        Linked data resource.
        2019 (Washington, DC Available at:)
        • Kenzik K.M.
        • Kent E.E.
        • Martin M.Y.
        • Bhatia S.
        • Pisu M.
        Chronic condition clusters and functional impairment in older cancer survivors: a population-based study.
        J Cancer Survivorship Res Pract. 2016; 10: 1096-1103
        • Kent E.E.
        • Ambs A.
        • Mitchell S.A.
        • Clauser S.B.
        • Smith A.W.
        • Hays R.D.
        Health-related quality of life in older adult survivors of selected cancers: data from the SEER-MHOS linkage.
        Cancer. 2015; 121: 758-765
        • Hays R.D.
        • Farivar S.S.
        • Liu H.
        Approaches and recommendations for estimating minimally important differences for health-related quality of life measures.
        COPD. 2005; 2: 63-67
        • Katz S.
        Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living.
        J Am Geriatr Soc. 1983; 31: 721-727
        • Katz S.
        • Downs T.D.
        • Cash H.R.
        • Grotz R.C.
        Progress in development of the index of ADL.
        Gerontologist. 1970; 10: 20-30
        • Selim A.
        • Rogers W.
        • Qian S.
        • Rothendler J.A.
        • Kent E.E.
        • Kazis L.E.
        A new algorithm to build bridges between two patient-reported health outcome instruments: the MOS SF-36(R) and the VR-12 Health Survey.
        Qual Life Res. 2018; 27: 2195-2206
        • McHorney C.A.
        • Ware Jr., J.E.
        • Raczek A.E.
        The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs.
        Med Care. 1993; 31: 247-263
        • Rogers W.
        • Rothendler J.A.
        • Selim A.
        • Qian S.
        • Kazis L.E.
        Adjustments for Mode and language for the SF-36 or VR-12 in the SEER-MHOS data resource.
        A Technical report submitted to the national cancer institute outcomes research Branch/Healthcare Delivery research Program, Division of cancer Control and population Sciences, National Cancer Institute. User’s Guide - Healthcare Delivery Research Program. 2017 (Washington, DC. Available at:)
        • Rogers W.
        • Rothendler J.A.
        • Selim A.
        • Qian S.
        • Kazis L E.
        Item to Item Bridges Between the SF-36 and VR-12 Health Surveys in the SEER-MHOS Data Resource. A Technical Report submitted to the National Cancer Institute Outcomes Research Branch/ Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences.
        National Cancer Institute, Washington, DC2016 (Available at:)
        • van den Boorn H.G.
        • Stroes C.I.
        • Zwinderman A.H.
        • et al.
        Health-related quality of life in curatively-treated patients with esophageal or gastric cancer: a systematic review and meta-analysis.
        Crit Rev Oncol Hematol. 2020; 154: 103069
        • Kauppila J.H.
        • Ringborg C.
        • Johar A.
        • Lagergren J.
        • Lagergren P.
        Health-related quality of life after gastrectomy, esophagectomy, and combined esophagogastrectomy for gastroesophageal junction adenocarcinoma.
        Gastric Cancer. 2018; 21: 533-541
        • Hu Y.
        • Zaydfudim V.M.
        Quality of life after Curative resection for gastric cancer: survey Metrics and Implications of surgical Technique.
        J Surg Res. 2020; 251: 168-179
        • Scholten L.
        • Stoop T.F.
        • Del Chiaro M.
        • et al.
        Systematic review of functional outcome and quality of life after total pancreatectomy.
        Br J Surg. 2019; 106: 1735-1746
        • Lounis L.
        • Aurran-Schleinitz T.
        • Turrini O.
        • Delpero J.R.
        • Brejard V.
        Psychological outcomes and quality of life in relation to pancreatectomy: a systematic review.
        Pancreas. 2019; 48: 471-479
        • Wee I.J.Y.
        • Syn N.
        • Lee L.S.
        • Tan S.S.
        • Chiow A.K.H.
        A systematic review and meta-analysis on the quality of life after hepatic resection.
        HPB (Oxford). 2020; 22: 177-186
        • Tohme S.
        • Sanin G.D.
        • Patel V.
        • et al.
        Health-related quality of life as a Prognostic factor in patients after resection of hepatic Malignancies.
        J Surg Res. 2020; 245: 257-264
        • O'Neill L.
        • Reynolds S.
        • Sheill G.
        • et al.
        Physical function in patients with resectable cancer of the pancreas and liver-a systematic review.
        J Cancer Survivorship Res Pract. 2020; 14: 527-544
        • Markar S.R.
        • Zaninotto G.
        • Castoro C.
        • et al.
        Lasting symptoms after esophageal resection (LASER): European multicenter Cross-sectional study.
        Ann Surg. 2020;
        • Hurria A.
        • Togawa K.
        • Mohile S.G.
        • et al.
        Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study.
        J Clin Oncol : official J Am Soc Clin Oncol. 2011; 29: 3457-3465
        • Hurria A.
        • Cirrincione C.T.
        • Muss H.B.
        • et al.
        Implementing a geriatric assessment in cooperative group clinical cancer trials: CALGB 360401.
        J Clin Oncol. 2011; 29: 1290-1296
        • Hurria A.
        • Gupta S.
        • Zauderer M.
        • et al.
        Developing a cancer-specific geriatric assessment: a feasibility study.
        Cancer. 2005; 104: 1998-2005
        • Badgwell B.
        • Stanley J.
        • Chang G.J.
        • et al.
        Comprehensive geriatric assessment of risk factors associated with adverse outcomes and resource utilization in cancer patients undergoing abdominal surgery.
        J Surg Oncol. 2013; 108: 182-186
        • Dale W.
        • Hemmerich J.
        • Kamm A.
        • et al.
        Geriatric assessment improves prediction of surgical outcomes in older adults undergoing pancreaticoduodenectomy: a prospective cohort study.
        Ann Surg. 2014; 259: 960-965
        • Moorthy K.
        • Wynter-Blyth V.
        Prehabilitation in perioperative care.
        The Br J Surg. 2017; 104: 802-803
        • Carli F.
        • Scheede-Bergdahl C.
        Prehabilitation to enhance perioperative care.
        Anesthesiol Clin. 2015; 33: 17-33
        • Silver J.K.
        Cancer prehabilitation and its role in improving health outcomes and reducing health care costs.
        Semin Oncol Nurs. 2015; 31: 13-30
        • Silver J.K.
        • Baima J.
        • Mayer R.S.
        Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship.
        Cancer J Clin. 2013; 63: 295-317
        • Silver J.K.
        • Baima J.
        Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes.
        Am J Phys Med Rehabil. 2013; 92: 715-727
        • Bruns E.R.
        • van den Heuvel B.
        • Buskens C.J.
        • et al.
        The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review.
        Colorectal Dis. 2016; 18: O267-O277
        • Halloway S.
        • Buchholz S.W.
        • Wilbur J.
        • Schoeny M.E.
        Prehabilitation interventions for older adults: an integrative review.
        West J Nurs Res. 2015; 37: 103-123
        • Bundred J.R.
        • Kamarajah S.K.
        • Hammond J.S.
        • Wilson C.H.
        • Prentis J.
        • Pandanaboyana S.
        Prehabilitation prior to surgery for pancreatic cancer: a systematic review.
        Pancreatology. 2020; 20: 1243-1250