Health status of older cancer survivors-results of the PolSenior study

Associations of frailty with symptoms, and HRQOL in older cancer survivors after cancer treatments: a systematic review and meta-analyses

PURPOSE

Frailty in older adult cancer survivors after cancer treatments is associated with various health outcomes. However, there is less agreement on how frailty affects symptoms and health-related quality of life (HRQOL). This systematic review and meta-analysis aimed to evaluate the current literature on frailty, symptoms, and HRQOL, as well as the associations of frailty with these factors in older adult cancer survivors with chemotherapy.

METHODS

A review was conducted on peer-reviewed publications from 2008 to 2023, using seven electronic databases. Meta-analyses were performed using random effects models to determine pooled effect estimates for frailty prevalence, symptom severity, and HRQOL scores.

RESULTS

A total of 26 studies involving older cancer survivors were included in the analysis. Most of these studies were conducted in Western countries and focused on White survivors, particularly those with breast cancer. The mean pooled prevalence of frailty was 43.5%. Among frail survivors, the most common symptoms reported after cancer treatments were pain (36.4%), neuropathy (34.1%), and fatigue (21.3%). Frailty was associated with higher pooled mean symptom severity (B = 1.23, p = 0.046) and lower functional HRQOL (B = - 0.31, p = 0.051, with marginal significance) after cancer treatments.

CONCLUSION

Frail older cancer survivors are at high risk of adverse symptoms and poor HRQOL after cancer treatment. Further research on screening for frailty is needed to prevent older adults from developing worse symptoms burden and maintain HRQOL. It is also essential to understand the mechanisms of the associations between frailty, symptoms and HRQOL in this population.

Coping Strategies Used by Older Cancer Survivors During the COVID-19 Pandemic: A Longitudinal Qualitative Study

Objectives: The objective of this study is to longitudinally examine the coping strategies used by older cancer survivors (≥60 years of age) during COVID-19. Methods: An interpretive descriptive approach was used to collect and analyse qualitative data collected via 1:1 telephone interviews at three timepoints: June/July 2020, January 2021, and March 2021. Main Findings: Coping strategies used by older adults reflected the resources available to them, and their agency in self-triaging and deciding on resources to support their coping. These decisions were impacted by pandemic-imposed restrictions and necessitated readjustment over time. Three themes were developed to describe coping strategies (including any changes): adapting means and methods to connect with others; being intentional about outlook; and taking actions toward a brighter future. Conclusion: Older adults used a variety of coping strategies, though their reliance on resources beyond themselves (e.g., family/friends) indicates a need to add tailored resources to existing professional services.

Age-related health deficits and five-year mortality among older, long-term cancer survivors

INTRODUCTION

Geriatric assessment evaluates multiple domains of health that, together, are superior to using chronologic age for predicting outcomes, such as hospitalization and mortality among patients with cancer. Most studies have not included comparison groups of individuals without cancer and assessed domains around the time of initial cancer diagnosis. Further, the potential for brief, self-reported measures to capture deficits that similarly predict mortality has not been well examined. This study compared age-related health deficit prevalence between older, long-term cancer survivors and individuals without a cancer history, and estimated associations between deficits and mortality risk among survivors.

MATERIALS AND METHODS

Analyses included participants in the Cancer Prevention Study (CPS)-II Nutrition Cohort who were cancer-free at enrollment in 1992/1993 and completed the Patient Reported Outcome Measurement Information System® (PROMIS®) global health questionnaire in 2011. Age-related deficits in five domains (comorbidities, functional status, mental health, malnutrition/weight loss, and social support) were self-reported. Cancer information was self-reported and confirmed via medical records or state cancer registries. Vital status through 2016 and cause of death was ascertained by linkage with the National Death Index.

RESULTS

Analyses included 9979 participants (median age = 80) diagnosed with invasive cancer 5-20 years prior to completing the 2011 survey and 63,578 participants without a cancer history (median age = 79). Overall deficits in the five domains were similar among long-term cancer survivors and controls. However, survivors of specific cancer types - non-Hodgkin lymphoma (NHL), lung, and kidney cancer - were more likely to report deficits in mental health and functional status than the control group. Among all survivors, each domain was independently associated with all-cause mortality, particularly functional status (hazard ratio [HR] = 2.02; 95% confidence interval [CI]: 1.80-2.27) and mental health (HR = 1.84; 95% CI: 1.65-2.04). Mortality risk increased with the number of deficits.

DISCUSSION

These results suggest that, several years after treatment, NHL, lung, and kidney cancer survivors are still more likely to experience age-related deficits compared to other similarly-aged individuals. Furthermore, results show that shorter, self-reported physical and mental health assessments, such as the PROMIS® global health questions, are predictive of mortality among older, long-term cancer survivors and, therefore, may be useful in clinical and research settings.

Challenges of Survivorship for Older Adults Diagnosed with Cancer

Purpose of Review

The purpose of this brief review is to highlight significant recent developments in survivorship research and care of older adults following cancer treatment. The aim is to provide insight into care and support needs of older adults during cancer survivorship as well as directions for future research.

Recent Findings

The numbers of older adult cancer survivors are increasing globally. Increased attention to the interaction between age-related and cancer-related concerns before, during, and after cancer treatment is needed to optimize outcomes and quality of life among older adult survivors. Issues of concern to older survivors, and ones associated with quality of life, include physical and cognitive functioning and emotional well-being. Maintaining activities of daily living, given limitations imposed by cancer treatment and other comorbidities, is of primary importance to older survivors. Evidence concerning the influence of income and rurality, experiences in care coordination and accessing services, and effectiveness of interventions remains scant for older adults during survivorship.

Summary

There is a clear need for further research relating to tailored intervention and health care provider knowledge and education. Emerging issues, such as the use of medical assistance in dying, must be considered in this population.

Polypharmacy in Polish Older Adult Population-A Cross-Sectional Study: Results of the PolSenior Project

Polypharmacy is a challenging issue in geriatrics. The aim of the study was to characterize correlates of polypharmacy in the PolSenior project. The PolSenior project, was a comprehensive survey in a large and longitudinal representative sample of thePolish older population. The project was conducted by the International Institute of Molecular and Cell Biology in Warsaw between 2008 and 2011. All medications consumed during the week preceding the survey were evaluated for each participant (n = 4793, including 2314 females (48.3%)). Thereafter, the percentage of those with polypharmacy (at least 5 medications) and excessive polypharmacy (at least 10 medications) was calculated, and their correlates were determined. The average number of medications used by participants was 5.1 ± 3.6, and was higher in females than in males (5.5 ± 3.5 vs. 4.8 ± 3.5; p < 0.001). Polypharmacy characterized 2650 participants (55.3%) and excessive polypharmacy—532 of them (11.1%). The independent correlates associated withpolypharmacy were: age over 70 years, female sex, higher than primary education, living in an urban area, comorbidities, any hospitalization during past five years, and visiting general practicioners at least yearly. As for correlates with excessive polypharmacy, they were: age 80–84 years, female sex, living in an urban area, diagnosis of at least four chronic diseases, and at least two hospitalizations in the last five years. This study serves as a starting place to understand patient characteristics associated with polypharmacy, excessive polypharmacy, and identify targeted interventions.

Prevalence vs impact: a mixed methods study of survivorship issues in colorectal cancer

Purpose

This study aims to explore the prevalence of CRC survivorship issues and their impact on survivors’ quality of life (QoL).

Methods

This study utilised a mixed methods sequential explanatory design. Adult CRC survivors between 6- and 60-months post-diagnosis (n = 304) were purposively recruited from three hospitals and twenty-one cancer support centres in Ireland. QoL was evaluated using the EuroQol and FACT-C questionnaires and results compared to population norms. 22 survey participants took part in semi-structured interviews exploring the impact of survivorship issues on their daily lives.

Results

While CRC survivors reported QoL outcomes comparable to or better than normative populations, 54% were dissatisfied with their QoL. The most common survivorship issues reported included negative body image (74%), fatigue (68%), sexual dysfunction (66%) and sleep disturbance (59%). Thematic analysis of the qualitative data illustrated survivors’ attempts to live with the impact of cancer and its treatment (loss, fear, impact) and striving to contextualise, reframe and understand the consequences of cancer and its treatment (control, vigilance, benefit). Within these themes, the cross-domain impact of less prevalent symptoms including bowel dysfunction (28–57%) and peripheral neuropathy (47%) were widely discussed.

Conclusions

Although cancer survivors report positive QoL outcomes, many experience distressing physical, psychological and social effects. The findings suggest less common and difficult to manage symptoms are the greatest source of distress and unmet need. Support and information must be tailored to address survivors’ individual needs and preferences for support, informed by holistic person-centred assessment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-02975-2.

Exercise levels and preferences on exercise counselling and programming among older cancer survivors: A mixed-methods study

OBJECTIVES

To assess exercise levels and exercise counselling /programming preferences among older cancer survivors.

MATERIALS AND METHODS

A mixed-methods study design was employed. Quantitative instruments on exercise levels, exercise counselling and programming preferences, frailty status, and cancer-related symptoms were administered to 290 post-treatment older cancer survivors aged ≥65. Twelve participants with different exercise levels and different views on exercise counselling and programming were purposively selected to participate in semi-structured interviews.

RESULTS

Overall, 58.3% of participants did not meet the recommended exercise guidelines, and 44.1% were not engaging in any vigorous or moderate exercise. Frail survivors were less likely to meet the guidelines (aOR = 0.194, 95%CI = 0.053, 0.712) compared to their robust counterparts. However, 66.9% and 62.8% of participants expressed a definite or possible interest in receiving exercise counselling and participating in an exercise program, respectively. Particularly, survivors who are male, did not receive chemotherapy, are less educated, and have higher symptom burden were less likely to show interest. Most preferred low-intensity exercise (59.8%) and wanted to start the exercise program after treatment (68.2%), which differs from the literature on general adult survivors. The major trigger to initiate and maintain exercise behaviors was the benefits of exercise and a common barrier to exercising was lack of time.

CONCLUSION

Most older cancer survivors did not meet the recommended exercise guidelines, but they were open to exercise counselling and programming. Reviewing education on the benefits of exercise is especially important after treatment completion to promote healthy lifestyles.

Interventions for Loneliness Among Adult Cancer Survivors: A Systematic Review and Meta-Analysis

Problem identification: Loneliness is common after cancer, contributing to poor outcomes. Interventions to modify loneliness are needed. This systematic review describes the current literature regarding loneliness interventions in cancer survivors.Literature search: Databases including: Ovid/MEDLINE; The Cochrane Central Register of Controlled Trials (CENTRAL); Elsevier/Embase; Clarivate/Web of Science (Core Collection), EBSCO/PsycINFO, EBSCO/CINAHL were used to perform a systematic review of literature using PRISMA guidelines. Second, risk of bias, meta-analysis and a narrative synthesis approach was completed to synthesize findings from multiple studies.Data evaluation/synthesis: Six thousand five hundred three studies were initially evaluated; eight studies met inclusion criteria. Findings indicate a paucity of interventions, generally of lower quality. Interventions were feasible and acceptable; those interventions with cultural modifications were more likely to demonstrate effectiveness.Conclusions: There are limited interventions addressing loneliness in cancer survivors. Development and testing of culturally-relevant programs are warranted.Implications for psychosocial oncology: Current studies suggest the psychosocial symptom of loneliness is modifiable among adult cancer survivors. Few interventions have been tested and shown to be effectiveness in cancer survivors in the U.S. and none have been tailored for older adult survivors, by patient gender/sex and few for specific race/ethnic groups. Results from this systematic review: a narrative synthesis and meta-analysis can inform future interventions targeting loneliness in this growing, yet vulnerable, adult cancer survivor population.

Health status of middle-aged and older cancer survivors: a nationwide cross-sectional study from the China Health and Retirement Longitudinal Study (CHARLS)

Background

The number of Chinese cancer survivors has increased bolstered by the combined trends of an aging population and improved cancer survival; however, related research on cancer survivorship remains limited. Therefore, this study aimed to provide an overview of the health status of middle-aged and older cancer survivors in China.

Methods

We used the cross-sectional self-reported survey data from wave 4 in the China Health and Retirement Longitudinal Study (CHARLS). A total of 354 cancer survivors and 16,664 participants without cancer were identified from CHARLS. Physical and mental health, health behavior, and health care information collected by questionnaire were compared between these two groups.

Results

Compared with the general middle-aged and older population, cancer survivors had more concomitant chronic diseases (2.75 vs. 2.00, P<0.001). In addition, cancer survivors were found to be more statistically likely to have difficulties with activity (3.53 vs. 2.39, P<0.001) and have depressive symptoms (10.07 vs. 8.01, P<0.001) compared with participants without cancer. Also, cancer survivors were less likely to drink compared to those without a cancer diagnosis (OR 0.49; 95% CI, 0.36–0.66, P<0.001), but smoking behavior and physical activity did not show a significant difference. Coexisting chronic diseases and smoking harmed the physical and mental health of middle-aged and older people. We also found that cancer survivors had higher medical care expenses when compared with participants without cancer.

Conclusions

Cancer survivors older than 45 years in China have poorer outcomes in comorbidities and physical and mental health than their age-matched individual counterparts without cancer. Therefore, a higher quality and more cost-effective supportive care for these individuals is needed.

Similarities and differences in the correlates of comorbidities in US male and female adult cancer survivors

OBJECTIVES

To determine both the common and the sex-specific correlates of comorbidities in adult male and female cancer survivors.

DESIGN

Cross-sectional study using the 2009-2014 National Health and Nutrition Examination Survey (NHANES).

SAMPLE

Male (n = 667) and female (n = 772) cancer survivors 20 years of age and older.

MEASUREMENTS

Questionnaire responses from NHANES provided data for this study. Comorbidities were assessed using a modified Charlson Comorbidity Index (CCI). Bivariate and multivariate linear regression analyses were conducted to identify correlates of comorbidities in male and female cancer survivors separately.

RESULTS

The mean modified CCI score was 3.88 in males and 3.68 in females. Having a greater number of cancers diagnosed, being currently or formerly married, being physically inactive, having lower socioeconomic status, and being a former smoker were significant correlates of comorbidities in both males and females. Having a prostate cancer diagnosis was also a significant correlate of comorbidities in males. White race, more years since first cancer diagnosis, being overweight or obese, and having no more than a high school education were also significant correlates of comorbidities in females.

CONCLUSIONS

There are differences between correlates of comorbidities in male and female cancer survivors.