Disability and quality of life in community-dwelling elderly cancer survivors: Case-control study in the Korean population

Quality of life in older patients with cancer and related unmet needs: a scoping review

BACKGROUND

Older patients form the largest group of cancer patients yet remain underrepresented in clinical research. This scoping review aims to synthesize findings on quality of life (QoL) in older adults with cancer, comparing them to younger counterparts and older individuals without cancer, and identifying associated factors.

METHODS

PubMed and PsychINFO databases were searched for articles published until January 2024. Studies were included with exclusively older adults with cancer (≥ 65 years), age-mixed samples (mean/median ≥ 70 years), or that report results separately for older and younger adults with cancer. Out of 6, 397 identified studies, 87 met the inclusion criteria.

RESULTS

Most studies were cross-sectional, conducted in 14 countries with a mean age of 74.2 years. Physical QoL (PQoL) demonstrates an age-related decline, primarily influenced by comorbidity burden, physical activity, and lifestyle. In contrast, mental QoL (MQoL) remained stable or increased with advancing age, reflecting resilience and effective coping by older patients. While cognitive and role functioning tended to show stable or declining values with age, findings regarding social functioning were mixed. Socioeconomic factors, e.g. education, income, or marital status, mainly impacted MQoL, as well as other QoL domains. Symptom management and social support represent unmet needs that contribute to QoL impairments. Older adults with cancer underreport symptoms they perceive as normal for their age, experience ageism in healthcare, and reduced social participation.

INTERPRETATION

Comprehensive, multidisciplinary cancer care is essential for older adults with cancer, focusing on the prevention of functional health decline, geriatric assessment, socioeconomic health disparities, and enhancing symptom management.

The changing relationship between health burden and work disability of Australian cancer survivors, 2003-2017: evidence from a longitudinal survey

BACKGROUND

The purpose of this study was to examine the relationship between the cancer health burden and themagnitude of work disability on cancer survivors in Australia from 2003 to 2017.

METHODS

A longitudinal prospective study design was undertaken among cancer patients using data from the Household, Income and Labour Dynamics in Australia survey. The longitudinal effect was captured using a fixed effect multinomial logistic regression model, which predicted changes in the relationship between cancer burden and work disability level controlling for socio-demographic, lifestyle and life conditions predictors.

RESULTS

The prevalence of long-term disability among cancer survivors was 50%, with 18% of patients experiencing extreme work disability. The magnitude of disability levels increased significantly with the level of health burden. Cancer survivors who faced a severe health burden were at 5.32 times significantly higher risk of having work disability compared with patients who had no health burden. Other potential predictors, such as older patients (relative risk ratio, RRR = 1.82; 95% CI: 1.57, 5.87), those engaged in lower levels of physical activities (RRR = 1.91; 95% CI: 1.07, 3.40), those who drink alcohol (RRR = 1.29; 95% CI: 1.15, 1.49), and poor socioeconomic status (RRR = 1.28; 95% CI: 1.16, 2.23) were all significantly associated with extreme work disability.

CONCLUSION

A substantial proportion of cancer survivors experienced work disability which was more pronounced with the magnitude of the cancer health burden. The different dimensions of disability might be prevented by introducing cancer survivor-specific evidence-based interventions, and incorporating comprehensive social support. Recommendations to improve public health policy aimed at reducing population-level unhealthy lifestyle behaviours include: using these findings to better outline the management of a sequelae course of treatment for cancer survivors; and identifying those who should undergo more intensive physical rehabilitation aimed at reducing their work disability level.

A Review of the Development and Application of Generic Preference-Based Instruments with the Older Population

Older people (aged 65 years and over) are the fastest growing age cohort in the majority of developed countries, and the proportion of individuals defined as the oldest old (aged 80 years and over) living with physical frailty and cognitive impairment is rising. These population changes put increasing pressure on health and aged care services, thus it is important to assess the cost effectiveness of interventions targeted for older people across health and aged care sectors to identify interventions with the strongest capacity to enhance older peoples' quality of life and provide value for money. Cost-utility analysis (CUA) is a form of economic evaluation that typically uses preference-based instruments to measure and value health-related quality of life for the calculation of quality-adjusted life-years (QALYS) to enable comparisons of the cost effectiveness of different interventions. A variety of generic preference-based instruments have been used to measure older people's quality of life, including the Adult Social Care Outcomes Toolkit (ASCOT); Health Utility Index Mark 2 (HUI2); Health Utility Index Mark 3 (HUI3); Short-Form-6 Dimensions (SF-6D); Assessment of Quality of Life-6 dimensions (AQoL-6D); Assessment of Quality of Life-8 dimensions (AQoL-8D); Quality of Wellbeing Scale-Self-Administered (QWB-SA); 15 Dimensions (15D); EuroQol-5 dimensions (EQ-5D); and an older person specific preference-based instrument-the Investigating Choice Experiments Capability Measure for older people (ICECAP-O). This article reviews the development and application of these instruments within the older population and discusses the issues surrounding their use with this population. Areas for further research relating to the development and application of generic preference-based instruments with populations of older people are also highlighted.

Effects of Peer-Led Interventions for Patients With Cancer: A Meta-Analysis

PROBLEM IDENTIFICATION

To evaluate the effects of peer-led supportive interventions for patients with cancer.
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LITERATURE SEARCH

Six electronic databases (EMBASE, MEDLINE®, Google Scholar, Cochrane Library, ProQuest Medical Library, and CINAHL®) were searched for articles published from 1997 to May 2017.
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DATA EVALUATION

A total of 159 studies were identified. Eighteen (16 randomized, controlled trials [RCTs] and 2 non-RCTs) were eligible for systematic review and 16 for meta-analysis. The Cochrane risk of bias tool and Comprehensive Meta-Analysis software were used for analysis.
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SYNTHESIS

The authors synthesized the results of the effect size of each trial according to cancer symptoms, coping, emotional health, quality of life, self-efficacy, sexuality, social support, and health-related behaviors. 
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IMPLICATIONS FOR RESEARCH

The findings from this study suggest that an additional tiered evaluation that has a theoretical underpinning and high-quality methodology is required to confirm the efficacy of peer-led supportive interventions within cancer care models.

Communication Behaviors in Nursing Homes in South-East Iran: An Ethnographic Study

Background:

Because of the increasing number of the elderly, the need for care in aged nursing homes (NHs) is increasing. As a cultural perspective toward care is new, it is very important to understand the communication behavior of the elderly in various cultures. This study aimed to explore the communication behaviors among the elderly in NHs in Kerman, Iran.

Materials and Methods:

This ethnographic focused study was conducted on 25 staff members and 8 residents in two NHs in 2015. Data were collected through observation of the participants, field notes, and semi-structured deep interviews in Kerman. Cuba and Lincoln method was used to ensure the trustworthiness of the data. The collected data were analyzed through content analysis.

Results:

By analyzing primary codes, 3 categories and 8 subcategories were extracted through content analysis including fluctuation in communication (task-oriented communication, avoidance of communication, and establishment of effective communication), artificial collaboration (fake friendships, jealousy, and its consequences, and cooperation in concealing error), and lack of collaboration among team members (fragmented teamwork, extreme working conditions, and physical burnout among the elderly).

Conclusions:

The results of this study indicate that communication problems between caregivers and the elderly are high. Thus, it is necessary that people who care for elderly indiviuals are trained regarding special communication strategies and skills, and they are not influenced by fatigue and burnout resulting from caring.