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P103 International comparisons of cancer mortality rates in the elderly
Proffered papers, Posters P102 Depression risk in elderly cancer patients A. Giacalone *, L. Fratino, J. Polesel, D. Crivellari, A. Bearz, M. Spina, M.G. Michieli, S. Santarossa, P. Nigri, U. Tirelli. National Cancer Institute, Aviano (PN), Italy Purpose of the study: Depression is a common symptom in cancer, with clinically significant symptoms reported by up to 25% of elderly cancer patients (ECP). Its presence has been associated with increased risk for resource requirements and caregiving needs, and worse outcomes. The present study reports on the presence of depressive symptoms in cancer patients older than 70 years of age. Method(s): Since February 2007 we routinely evaluated elderly outpatients with a histological diagnosis of cancer by means of the Comprehensive Geriatric Assessment as a screening tool for decision-making. The GDS-5 (Geriatric Depression Scale, 5-item version) was employed to assess the presence of depressive symptoms. A semi-structured clinical interview was employed to evaluate the social status of the patient and the knowledge of the diagnosis. Multivariate logistic regression models were applied to calculate odds ratio (OR) for depressive symptoms, and relative 95% confidence intervals (CI), according to the main ECP characteristics. Result(s): From February 2007 to June 2009, 211 ECP (117 females) were evaluated. The median age was 77 years (range 70−90); 24% lived alone or in nursing homes; 60% had a living spouse. ECP were mostly affected by breast (29%), hematological (25%), lung (15%), or renal (7%) cancer; 8% had ECOG performance status 2. ADL was 5 for 94% of ECP, and IADL was 5 for 86% of patients. Eleven percent of ECP were affected by relevant co-morbidities. The diagnosis was known by 78% of the patients. Depressive symptoms were present in 31% of ECP. ADL scores below 5 (OR = 6.8, 95& CI: 1.2–38.3) and ECOG performance status 2 (OR = 5.5, 95& CI: 1.3–23.3) were significantly associated to depressive symptoms. No other EPC characteristics emerged to be associated in the multivariate model. Conclusion(s): Our data show that the presence of depressive symptoms in ECP is mostly due by the impairment in the activities of daily living rather than by age, IADL, knowledge of diagnosis, or being alone. Even if there are no data till today to establish depression as independent predictor of mortality in ECP, depressive mood is an important aspect to consider when approaching the elderly cancer patients, especially for the decision-making process.
Miscellaneous P103 International comparisons of cancer mortality rates in the elderly H. Moller, A. Moran *. North West Cancer Intelligence Service, Manchester, United Kingdom Purpose of the study: The study compares progress in cancer control in the elderly between countries in Europe and North America. Method(s): Death data were obtained for the WHO mortality database for (i) the UK, (ii) USA, (iii) Northern Europe (Denmark, Finland, Iceland, Norway, Sweden) and (iv) Western Europe (Austria, France, Germany, Luxembourg, Netherlands, Switzerland). Cancer mortality rates were calculated for each of the four populations listed above for 55−64, 65−74, 75−84 and 85 plus age groups for the period 1995–2005. Rates were calculated for all sites combined and for breast, colorectal, lung, all but lung and prostate cancers. Excess cancer deaths were calculated for the UK by subtracting from the recorded number of cancer deaths the number of deaths that would have occurred if the UK had the same death rate as the population with the lowest rate for each of the four age groups. Result(s): Cancer mortality rates for 2003−05 for the 75−84 and 85 plus age groups in the UK were bwtween 11% and 31% higher than for the other three populations. While rates between 1995−97 and 2003−05 for the UK dropped by 16% in the under 75s, rates in the 75−84 age group have dropped by only 6% and have actually risen by 2% in the 85 plus,
S55 compared with decreases of between 4% and 16% in the over 85s for the other populations. More than 15,000 excess cancer deaths occur each year in the UK in those aged 75 or over. In 2003–2005 cancer death rates for Northern Europe were 11% higher in 75−84 year olds and 4% higher in the 85 plus compared with Western Europe. The drop in rates form 1995−97 to 2003–2005 in Western Europe was 12% in the 75−84 and 16% in the 85 plus compared with decreases of 3% and 4% respectively in Northern Europe. Rates for the USA in the 75−84 age group are between those for Western and Northern Europe but are more than 10% lower for the over 85s. The most interesting results for the individual types of cancer will also be presented. Conclusion(s): The UK is making poor progress in decreasing cancer mortality rates in the elderly and the gap with other countries is increasing. Northern Europe has fallen behind both Western Europe and the USA. P104 The impact of a new cancer diagnosis on vulnerability in older Medicare beneficiaries S. Mohile *, Y. Xian, L. Fan. University of Rochester, Rochester, NY, USA Purpose of the study: In the elderly, measures of vulnerability such as disability and geriatric syndromes are associated with an increased risk for decline and death. Our research group previously reported that elders with any history of cancer have an increased likelihood of having disability, having geriatric syndromes, and meeting criteria for vulnerability and frailty. However, the impact of a new cancer diagnosis as compared to an older diagnosis of cancer on these measures has not been well described. Method(s): We analyzed a nationally representative sample of 12,480 community-based elders sampled in the 2003 Medicare Current Beneficiary Survey (MCBS). The prevalence of disability and geriatric syndromes of those with cancer diagnosed within 1 year was compared to those with an older diagnosis of cancer and those without cancer. We also evaluated the differences in scores on the Vulnerable Elders Survey-13 (VES-13), a screening tool that predicted an increased risk for decline or death in an earlier MCBS cohort, and meeting criteria for frailty as defined by Balducci. Multivariate logistic regressions were utilized to identify independent predictors of disability, geriatric syndromes, abnormal VES13 score, and meeting criteria for frailty. Result(s): Cancer was reported by 2344 (18.8%) pts which included 461 subjects who reported a cancer diagnosed within 1 year (new cancer) and 1883 subjects with an older diagnosis. Subjects with a new cancer diagnosis had a significantly higher prevalence of geriatric syndromes than those with an older diagnosis (63.0% versus 57.4%, P = 0.030). The prevalence of disability, vulnerability by VES-13 score, and frailty by Balducci criteria were similar between those with a new cancer diagnosis compared to an older diagnosis. Compared to those without cancer, subjects with a new cancer diagnosis had significantly higher prevalences of ADL deficit (34.4% versus 26.9%, P = 0.002), IADL deficit (44.5% versus 33.7%, P < 0.0001), and geriatric syndromes (63.0% versus 52.0%, P < 0.0001). Abnormal VES-13 scores and meeting criteria for frailty were also higher for subjects with a new diagnosis of cancer (45.1% versus 37.7%, P = .005 and 74.4% versus 68.4%, P = .013). Adjusting for confounders, subjects with a new diagnosis of cancer were significantly more likely to have an ADL deficit (OR 1.48, 95& CI: 1.17- 1.87), an IADL deficit (OR 1.81, 95& CI: 1.42–2.31), a geriatric syndrome (OR 1.70, 95& CI: 1.35–2.13), and abnormal VES-13 score (OR 1.37, 95& CI: 1.08–1.74) compared to those with an older diagnosis. Adjusting for confounders, subjects with a new diagnosis of cancer were significantly more likely to have an ADL deficit (OR 1.64, 95& CI: 1.30–2.07), an IADL deficit (OR 2.05, 95& CI: 1.61–2.62), a geriatric syndrome (OR 1.93, 95& CI: 1.57–2.36), abnormal VES-13 score (OR 1.64, 95& CI: 1.31–2.05), and frailty (OR 1.54, 95& CI: 1.21–1.96) compared to those without cancer. Conclusion(s): Subjects with a new cancer diagnosis have higher vulnerability than those with an older cancer diagnosis and those without cancer. Further research is needed to determine the reasons behind the associations between cancer and vulnerability to identify targets for improving cancer care and quality of life in older persons with cancer.
Miscellaneous P103 International comparisons of cancer mortality rates in the elderly H. Moller, A. Moran *. North West Cancer Intelligence Service, Manchester, United Kingdom Purpose of the study: The study compares progress in cancer control in the elderly between countries in Europe and North America. Method(s): Death data were obtained for the WHO mortality database for (i) the UK, (ii) USA, (iii) Northern Europe (Denmark, Finland, Iceland, Norway, Sweden) and (iv) Western Europe (Austria, France, Germany, Luxembourg, Netherlands, Switzerland). Cancer mortality rates were calculated for each of the four populations listed above for 55−64, 65−74, 75−84 and 85 plus age groups for the period 1995–2005. Rates were calculated for all sites combined and for breast, colorectal, lung, all but lung and prostate cancers. Excess cancer deaths were calculated for the UK by subtracting from the recorded number of cancer deaths the number of deaths that would have occurred if the UK had the same death rate as the population with the lowest rate for each of the four age groups. Result(s): Cancer mortality rates for 2003−05 for the 75−84 and 85 plus age groups in the UK were bwtween 11% and 31% higher than for the other three populations. While rates between 1995−97 and 2003−05 for the UK dropped by 16% in the under 75s, rates in the 75−84 age group have dropped by only 6% and have actually risen by 2% in the 85 plus,
S55 compared with decreases of between 4% and 16% in the over 85s for the other populations. More than 15,000 excess cancer deaths occur each year in the UK in those aged 75 or over. In 2003–2005 cancer death rates for Northern Europe were 11% higher in 75−84 year olds and 4% higher in the 85 plus compared with Western Europe. The drop in rates form 1995−97 to 2003–2005 in Western Europe was 12% in the 75−84 and 16% in the 85 plus compared with decreases of 3% and 4% respectively in Northern Europe. Rates for the USA in the 75−84 age group are between those for Western and Northern Europe but are more than 10% lower for the over 85s. The most interesting results for the individual types of cancer will also be presented. Conclusion(s): The UK is making poor progress in decreasing cancer mortality rates in the elderly and the gap with other countries is increasing. Northern Europe has fallen behind both Western Europe and the USA. P104 The impact of a new cancer diagnosis on vulnerability in older Medicare beneficiaries S. Mohile *, Y. Xian, L. Fan. University of Rochester, Rochester, NY, USA Purpose of the study: In the elderly, measures of vulnerability such as disability and geriatric syndromes are associated with an increased risk for decline and death. Our research group previously reported that elders with any history of cancer have an increased likelihood of having disability, having geriatric syndromes, and meeting criteria for vulnerability and frailty. However, the impact of a new cancer diagnosis as compared to an older diagnosis of cancer on these measures has not been well described. Method(s): We analyzed a nationally representative sample of 12,480 community-based elders sampled in the 2003 Medicare Current Beneficiary Survey (MCBS). The prevalence of disability and geriatric syndromes of those with cancer diagnosed within 1 year was compared to those with an older diagnosis of cancer and those without cancer. We also evaluated the differences in scores on the Vulnerable Elders Survey-13 (VES-13), a screening tool that predicted an increased risk for decline or death in an earlier MCBS cohort, and meeting criteria for frailty as defined by Balducci. Multivariate logistic regressions were utilized to identify independent predictors of disability, geriatric syndromes, abnormal VES13 score, and meeting criteria for frailty. Result(s): Cancer was reported by 2344 (18.8%) pts which included 461 subjects who reported a cancer diagnosed within 1 year (new cancer) and 1883 subjects with an older diagnosis. Subjects with a new cancer diagnosis had a significantly higher prevalence of geriatric syndromes than those with an older diagnosis (63.0% versus 57.4%, P = 0.030). The prevalence of disability, vulnerability by VES-13 score, and frailty by Balducci criteria were similar between those with a new cancer diagnosis compared to an older diagnosis. Compared to those without cancer, subjects with a new cancer diagnosis had significantly higher prevalences of ADL deficit (34.4% versus 26.9%, P = 0.002), IADL deficit (44.5% versus 33.7%, P < 0.0001), and geriatric syndromes (63.0% versus 52.0%, P < 0.0001). Abnormal VES-13 scores and meeting criteria for frailty were also higher for subjects with a new diagnosis of cancer (45.1% versus 37.7%, P = .005 and 74.4% versus 68.4%, P = .013). Adjusting for confounders, subjects with a new diagnosis of cancer were significantly more likely to have an ADL deficit (OR 1.48, 95& CI: 1.17- 1.87), an IADL deficit (OR 1.81, 95& CI: 1.42–2.31), a geriatric syndrome (OR 1.70, 95& CI: 1.35–2.13), and abnormal VES-13 score (OR 1.37, 95& CI: 1.08–1.74) compared to those with an older diagnosis. Adjusting for confounders, subjects with a new diagnosis of cancer were significantly more likely to have an ADL deficit (OR 1.64, 95& CI: 1.30–2.07), an IADL deficit (OR 2.05, 95& CI: 1.61–2.62), a geriatric syndrome (OR 1.93, 95& CI: 1.57–2.36), abnormal VES-13 score (OR 1.64, 95& CI: 1.31–2.05), and frailty (OR 1.54, 95& CI: 1.21–1.96) compared to those without cancer. Conclusion(s): Subjects with a new cancer diagnosis have higher vulnerability than those with an older cancer diagnosis and those without cancer. Further research is needed to determine the reasons behind the associations between cancer and vulnerability to identify targets for improving cancer care and quality of life in older persons with cancer.