ORLANDO — Hearing difficulties, depression, incontinence, osteoporosis, and falls are reported significantly more often by Medicare beneficiaries with a cancer history than by those who were never diagnosed with cancer, according to a survey of a nationally representative sample of beneficiaries.
Researchers compared reports of geriatric syndromes among 2,349 people with a cancer diagnosis history in the 2003 Medicare Current Beneficiary Survey with those among 10,128 people who did not have a cancer history. The overall difference was “highly statistically significant,” with 63% of the cancer history group reporting one or more geriatric syndromes vs. 57% of the controls, Dr. Supriya Gupta Mohile reported at the annual meeting of the American Society of Clinical Oncology.
History of cancer was independently associated with increased prevalence of self-reported falls (adjusted odds ratio 1.18), depression (OR 1.19), osteoporosis (OR 1.20), trouble hearing (OR 1.31), and incontinence (OR 1.35). It was not significantly associated with dementia/memory loss (adjusted OR 1.04), trouble seeing (OR 1.07), or trouble eating (OR 1.11).
“Clinicians should ask older cancer patients about geriatric syndromes in addition to comorbidity in order to fully evaluate their health status,” said Dr. Mohile, a geriatric oncologist at the University of Rochester (N.Y.).
The 12,477 Medicare beneficiaries studied were community-dwelling adults aged 65 years and older. The 18% who reported a relevant history had a diagnosis of nonskin malignancy. Also, to be considered a true geriatric syndrome, participants had to report symptoms severe or frequent enough to interfere with activities of daily living.
“Geriatric syndromes are highly prevalent in the elderly, especially in those who are frail,” Dr. Mohile said. The syndromes also are highly prevalent in newly diagnosed colon (45%), prostate (51%), and breast (35%) cancer patients (J. Clin. Oncol. 2006; 24:2304-10).
Compared with the controls in the current study, the cancer history group was older (mean age, 77.4 years vs. 76.5 years), more often white (89.7% vs. 86.2%), and more likely to have some college education (34.7% vs. 31.7%). A higher percentage of the cancer history group reported two or more comorbidities (34% vs. 30%).
“We also looked at impact of cancer subtype on numbers and specific types of geriatric syndromes,” Dr. Mohile said. Patients who reported the highest mean number of geriatric syndromes were those with a history of cervical/uterine (1.46) and lung (1.39) cancer. The mean number was smaller for those who reported breast (1.23), colon (1.13), and prostate (0.85) cancer.
A meeting attendee commented that Dr. Mohile could point to associations only between cancer history and geriatric syndromes. “We do have significant limitations,” Dr. Mohile said, noting that the study was cross-sectional, so causality could not be demonstrated.
“These aren't well coupled in causal relationships because of the methodology that was employed. We need better precision in the categorization of cancer treatment and sequelae in order to reach conclusions,” said study discussant Dr. Jerome Yates of the American Cancer Society.
A very heterogeneous participant sample and a small number of patients with some of the cancer subtypes were other limitations, Dr. Mohile said. Timing also is important, she added: “Our study was a self-report of cancer, and cancer could have occurred 10 years or more” before the 2003 survey.
It would interesting to perform a prospective study, said Dr. Harvey Jay Cohen of Duke University Medical Center, Durham, N.C., who moderated the session.
Dr. Yates also noted that the data might have been distorted because beneficiaries with higher comorbidity might have been followed more regularly by their clinicians, and because the cross-sectional design would be less likely to include participants who died sooner rather than later following their cancer diagnosis.
“This is a good start, using the Medicare database,” Dr. Yates added. “You are certainly on the right track, raising the right questions, and so that is very helpful.”
Future research is needed to assess whether cancer and/or treatment causes geriatric syndromes in older cancer patients, Dr. Mohile said.
Dr. Mohile and Dr. Yates had no relevant financial disclosures.