Cancer, Comorbidities, and Health-Related Quality of Life of Older Adults

By Smith, Ashley Wilder; Reeve, Bryce B. et al. | Health Care Financing Review, Summer 2008 | Go to article overview

Cancer, Comorbidities, and Health-Related Quality of Life of Older Adults


Smith, Ashley Wilder, Reeve, Bryce B., Bellizzi, Keith M., Harlan, Linda C., Klabunde, Carrie N., Amsellem, Marni, Bierman, Arlene S., Hays, Ron D., Health Care Financing Review


INTRODUCTION

By 2030, the number of Americans age 65 or over is expected to reach 71 million, double the 34.8 million documented in the year 2000, causing an unprecedented shift in the age structure of the U.S. population (Centers for Disease Control and Prevention, 2007). An individual reaching age 65 today could expect to live an additional 17.9 years, and older adults are increasingly concerned with the quality of those additional years. Advancing age is associated with an increased risk of cancer. Nearly 60 percent of new cancers and more than 70 percent of cancer deaths occur in individuals age 65 or over (Ries et al., 2007). Older age also is associated with other age-related health problems and chronic illness that can have adverse consequences on independent living, rates of disability, and ultimately the quality of life (Bellizzi and Rowland, 2007; Rao and Demark-Wahnefried, 2006; Yancik, 1997). Previous research in community cancer samples has shown high prevalence rates of comorbid conditions among cancer patients, with 69 to 88 percent reporting at least one comorbid condition (Kourokian, Murray, and Madigan, 2006; Ogle et al., 2000). There is also evidence that cancer patients report more comorbid medical conditions than do patients without a history of cancer (Bellizzi and Rowland, 2007). However, in national survey data, differences have been shown to be small among individuals age 65 or over with 52 percent of cancer patients versus 44 percent of individuals with no cancer history reporting at least one comorbidity (Hewitt, Rowland, and Yancik, 2003). Despite the expected increase in the numbers of people age 65 or over and the age-related nature of cancer and other chronic diseases, very little is known about whether older cancer patients have a greater number of comorbid conditions than do older patients without cancer. As a result, population-based research that explores the extent to which normative age-related comorbid diseases contribute to decrements in health-related quality of life (HRQOL) in older cancer patients is needed.

The potential adverse consequences of medical comorbidities pose a major clinical challenge for the care of older cancer patients, and comorbidity has been shown to be an important prognostic factor for patients with cancer (Piccifillo et al., 2004). A review of the literature suggests that in older cancer patients, comorbid conditions and their treatment may interact with cancer treatment and prognosis (Extermann, 2007) and also have been identified as relevant factors in the effects of treatment and mortality of cancer patients (D'Amico et al., 2008; Fouad et al., 2004). Clinicians must make cancer treatment decisions in the context of their patients' pre-existing health problems. We therefore need a more comprehensive understanding of relationships between comorbidities, cancer, and HRQOL to better address the health needs of older cancer patients.

One important data resource to help understand these relationships is the MHOS, conducted by the National Committee for Quality Assurance on behalf of CMS. The MHOS provides information on the HRQOL of Medicare managed care recipients. Previous research using the MHOS has shown that individuals with cancer reported significantly worse HRQOL on all 8 SF-36[R] scales, than those without cancer (Baker, Haffer, and Denniston, 2003). Data also have shown that the burden of cancer on both physical and mental health is not as great as that of most of the other measured comorbid conditions (Baker, Haffer, and Denniston, 2003; Ko and Coons, 2005). However, in these studies, all cancer types were collapsed and it was difficult to determine the relative impact of different types of cancer, or the recency of the cancer diagnosis. This has been an issue for large observational studies trying to disentangle effects of cancer and comorbidities on health status, where detailed information on cancer is limited (Bellizzi et al. …

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