Perceptions of medical status and treatment goal among older adults with advanced cancer.

Activities of Daily Living Aged Cost of Illness Goals Humans Neoplasms / therapy Quality of Life
Cancer Older adults Outcomes research Prognostic perceptions Prognostic understanding Symptoms

Journal

Journal of geriatric oncology
ISSN: 1879-4076
Titre abrégé: J Geriatr Oncol
Pays: Netherlands
ID NLM: 101534770

Informations de publication

Date de publication:
07 2020
Historique:
received: 30 07 2019
revised: 20 09 2019
accepted: 18 11 2019
pubmed: 10 12 2019
medline: 30 6 2021
entrez: 10 12 2019
Statut: ppublish

Résumé

Patient-reported medical status and treatment goal are measures of prognostic understanding with demonstrated relationships to important clinical and patient-reported outcomes in the general cancer population. Among older adults, relationships between these measures and other patient-reported (quality of life [QOL], symptoms, functional impairment) and clinical (hospitalization risk, survival) outcomes remains unclear. We enrolled patients ≥70 with advanced gastrointestinal cancers, collecting patient-reported medical status (terminally ill vs not), treatment goal (curative vs non-curative), QOL (EORTC-Elderly Cancer Patients), symptoms (Edmonton Symptom Assessment System [ESAS]), and functional impairment (activities of daily living [ADLs]). We also obtained information about hospitalizations and survival. To explore relationships between patient-reported medical status, treatment goal, QOL, symptoms, functional impairment, hospitalizations, and survival, we used regression models adjusted for age, sex, and education. Of 103 patients, 49.5% reported terminally ill status and 64.0% a non-curative treatment goal. Terminally ill status was associated with worse QOL (EORTC illness burden: 53.59 vs 35.26, p = 0.001), higher symptom burden (ESAS: 28.15 vs 16.79, p = 0.002), more functional impairment (ADLs: 3.63 vs 5.24, p = 0.006), greater hospitalization risk (HR = 2.41, p = 0.020), and worse survival (HR = 1.93, p = 0.010). We did not find associations between patient-reported treatment goal and these outcomes. In older adults with advanced cancer, report of terminally ill status was associated with other important patient-reported and clinical outcomes, suggesting disease severity may inform illness perceptions. We did not find similar associations for patient-reported treatment goal, indicating that questions related to medical status and treatment goal measure different constructs and more nuanced measures are needed.

Sections du résumé

BACKGROUND
Patient-reported medical status and treatment goal are measures of prognostic understanding with demonstrated relationships to important clinical and patient-reported outcomes in the general cancer population. Among older adults, relationships between these measures and other patient-reported (quality of life [QOL], symptoms, functional impairment) and clinical (hospitalization risk, survival) outcomes remains unclear.
METHODS
We enrolled patients ≥70 with advanced gastrointestinal cancers, collecting patient-reported medical status (terminally ill vs not), treatment goal (curative vs non-curative), QOL (EORTC-Elderly Cancer Patients), symptoms (Edmonton Symptom Assessment System [ESAS]), and functional impairment (activities of daily living [ADLs]). We also obtained information about hospitalizations and survival. To explore relationships between patient-reported medical status, treatment goal, QOL, symptoms, functional impairment, hospitalizations, and survival, we used regression models adjusted for age, sex, and education.
RESULTS
Of 103 patients, 49.5% reported terminally ill status and 64.0% a non-curative treatment goal. Terminally ill status was associated with worse QOL (EORTC illness burden: 53.59 vs 35.26, p = 0.001), higher symptom burden (ESAS: 28.15 vs 16.79, p = 0.002), more functional impairment (ADLs: 3.63 vs 5.24, p = 0.006), greater hospitalization risk (HR = 2.41, p = 0.020), and worse survival (HR = 1.93, p = 0.010). We did not find associations between patient-reported treatment goal and these outcomes.
CONCLUSIONS
In older adults with advanced cancer, report of terminally ill status was associated with other important patient-reported and clinical outcomes, suggesting disease severity may inform illness perceptions. We did not find similar associations for patient-reported treatment goal, indicating that questions related to medical status and treatment goal measure different constructs and more nuanced measures are needed.

Identifiants

DOI: 10.1016/j.jgo.2019.11.005 PMID: 31813839
pubmed: 31813839
pii: S1879-4068(19)30351-0
doi: 10.1016/j.jgo.2019.11.005
pii:
doi:

Types de publication

Journal Article Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

937-943

Subventions

Organisme : NCI NIH HHS
ID : K24 CA181253
Pays : United States

Informations de copyright

Published by Elsevier Ltd.

Déclaration de conflit d'intérêts

Declaration of Competing Interest None of the authors have financial conflict of interest to report.

Auteurs

Leah L Thompson (LL)

Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, MA, USA. Electronic address: leah_thompson@hms.harvard.edu.

Brandon Temel (B)

Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, MA, USA.

Charn-Xin Fuh (CX)

Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, MA, USA.

Christine Server (C)

University of Maryland School of Medicine, Baltimore, MD, USA.

Paul Kay (P)

Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, MA, USA.

Sophia Landay (S)

Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, MA, USA.

Daniel E Lage (DE)

Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, MA, USA.

Lara Traeger (L)

Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.

Erin Scott (E)

Department of Medicine, Division of Palliative Care and Geriatrics, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.

Vicki A Jackson (VA)

Department of Medicine, Division of Palliative Care and Geriatrics, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.

Joseph A Greer (JA)

Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.

Areej El-Jawahri (A)

Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, MA, USA.

Jennifer S Temel (JS)

Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, MA, USA.

Ryan D Nipp (RD)

Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, MA, USA.

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Classifications MeSH

questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Réadaptation › Activités de la vie quotidienne › Perceptions of medical status and treatment...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Perceptions of medical status and treatment...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enquêtes et questionnaires › Enquêtes de santé › Indicateurs d'état de santé › Coûts indirects de la maladie › Perceptions of medical status and treatment...
questionsmedicales.fr › Comportement et mécanismes comportementaux › Objectifs › Perceptions of medical status and treatment...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Perceptions of medical status and treatment...
questionsmedicales.fr › Tumeurs › Perceptions of medical status and treatment...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Mesures épidémiologiques › Démographie › État de santé › Qualité de vie › Perceptions of medical status and treatment...