klimop: a cohort study on the wellbeing of older cancer patients
DESCRIPTION
KLIMOP: a cohort study on the wellbeing of older cancer patients. Laura Deckx - PowerPoint PPT PresentationTRANSCRIPT
KLIMOP: a cohort study on the wellbeing of older cancer patients
Laura Deckx
Liesbeth Daniels, Katherine Nelissen, Piet Stinissen, Paul Bulens, Loes Linsen, Jean-Luc Rummens, Doris van Abbema, Franchette van den Berkmortel, Hans
Wildiers, Vivianne C. Tjan-Heijnen, Marjan van den Akker, Frank Buntinx
Klimop
• Klimop was conceptualised by Prof. Buntinx and Dr. Bulens after
a study performed by LIKAS in 2007 among stakeholders
• “Cancer in Limburg: Challenges and strategic options
for a coordinated approach “
• This study showed that the challenges in cancer care will be:
– The psychosocial aspects of cancer care
– Scientific research for older cancer patients
Survival: quantity or quality?
• Survival: quantity
– Survival of cancer patients increases
– Not for older cancer patients: EUROCARE project (Quaglia 2009)
• Survival: quality
– The fear to loose autonomy > the fear to die (Jolly 2006)
– Macmillan Listening Study: To study the impact of cancer on everyday life was defined as the top priority area for cancer research (Okamoto 2011)
Klimop-study
To assess the impact of cancer, ageing and their interaction on
subsequent wellbeing of older cancer patients
Inclusion (January 2011)
Baseline 6 months 1 year ...
Younger cancer patients 168 84 30
Older cancer patients 100 44 7
Older patients without cancer 157 84 25
Total interviewed 425 212 62
Lost to follow-up / 40 4
Deceased / 14 3
Comorbidity
• Comorbidity: the co-occurence of different diseases
• Comorbidity is an enormous problem (Marengoni 2011)
– Highly prevalent (55% - 98%)
– Cause of disability, functional impairment, low Qol, high health care costs
– Survival
Comorbidity
Guidelines to for the treatment of cancer patients with comorbidity are lacking! (Signaleringscommissie Kanker van KWF Kankerbestrijding 2011)
Functional status
• Maintenance of independence is very important
• Associated with survival
• Cancer patients have more functional problems (Hewitt 2003, Keating 2005)
• Little prospective studies that investigate the risk factors for
functional decline in older cancer patients
→ Cave! Selection of participants
Functional status* :Baseline ~ 6 months
Worse Idem Better
Baseline N (%) N (%) N (%)
Younger cancer patients
Impaired 16 (10%) 39 (46%) 37 (44%) 8 (10%)
Not impaired 152 (90%)
Older cancer patients
Impaired 23 (23%) 12 (27%) 21 (48%) 11 (25%)
Not impaired 77 (77%)
Older patients without cancer
Impaired 45 (19%) 17 (20%) 53 (63%) 14 (17%)
Not impaired 112 (71%)
*Functional status (ADL en IADL): Computed as described by Kellen et al. 2010
Baseline Functional status* ~ Loneliness
Impaired Not impaired
N N OR 95% CI
Younger cancer patients
Lonely 27 (18%) 4 23 2.2 0.6 – 7.8
Not lonely 124 (82%) 9 115
Older cancer patients
Lonely 26 (35%) 10 16 4.4 1.4 – 14.0
Not lonely 48 (65%) 6 42
Older patients without cancer
Lonely 56 (38%) 17 39 1.2 0.6 – 2.5
Not lonely 91 (62%) 24 67
*Functional status (ADL en IADL): Computed as described by Kellen et al. 2010
Depression
• Depression is important:
– Leading cause of disability worldwide
– Commonly coexists
– Predicts overall survival (Kanesvaran 2011 JCO)
• Depression decreased – overall survival increased!
(Giese-Davis 2011 JCO)
• Results are inconclusive
Depression:Baseline ~ 6 months
Worse(>10%)
Idem Better(>10%)
Baseline N (%) N (%) N (%)
Younger cancer patients
Depressive feelings 12 (8%) 11 (15%) 44 (59%) 20 (27%)
No depressive feelings 139 (92%)
Older cancer patients
Depressive feelings 11 (14%) 5 (18%) 18 (64%) 5 (18%)
No depressive feelings 66 (86%)
Older patients without cancer
Depressive feelings 18 (12%) 8 (11%) 51 (71%) 13 (18%)
No depressive feelings 133 (88%)
Baseline Depression ~ Loneliness
GDS-15 ≥ 5
GDS-15< 5
N N OR 95% CI
Younger cancer patients
Lonely 25 (17%) 5 20 4.8 1.3 – 17.1
Not lonely 120 (83%) 6 114
Older cancer patients
Lonely 25 (35%) 7 18 8.6 1.6 – 45.2
Not lonely 46 (65%) 2 44
Older patients without cancer
Lonely 55 (38%) 14 41 9.9 2.7 – 36.4
Not lonely 90 (62%) 3 87
Quality of life
• What is the impact of cancer, cancer treatment, ageing and
their interaction on Qol?
– Results are inconclusive
• Methodological shortcomings (Joly 2007)
– Cross-sectional
– Presentation of mean values!
– Prospective but Qol measured only once
– Selection of patients
Global Qol:Baseline ~ 6 months
Worse(>10%)
Idem Better(>10%)
N (%) N (%) N (%)
Younger cancer patients
Global Qol 31 (38%) 15 (19%) 35 (43%)
Older cancer patients
Global Qol 18 (55%) 8 (24%) 7 (21%)
Older patients without cancer
Global Qol 17 (21%) 35(43%) 30 (37%)
Wellbeing
Little is known about the
interaction between the
co-occurrence of
-Comorbidity
-Functional impairment
-Geriatric syndromes
(Koroukian 2011 JCO)
Preliminary conclusions
• Results are preliminary and cross-sectional! The longer the duration
of the study, the more valuable the results will be
• Loneliness and depression are frequent and important factors that
can be influenced
• Guidelines for care of cancer patients with multimorbidity are
needed, taking into account:
– Co-morbidity/functional impairment/…
– Consequences of cancer treatment
– Collaboration between different disciplines in primary and secondary care
Take home message
• Be critical!– Was the study population appropriate?– Cross-sectional design versus prospective design?
• Older cancer patients
– Heterogeneous group
– Specific health care needs
• Quality rather than quantity of survival
– Which factors determine maintenance or decline of wellbeing?
“Knowing is not enough; we must apply. Willing is not enough; we must do.” Goethe
[email protected]@[email protected]
www.ouderenenkanker.be
Deckx L, Van Abbema D, Nelissen K, Daniels L, Stinissen P, Bulens P, Linsen L, Rummens JL, Van den Berkmortel F, Robaeys G, De Jonge E, Houben B, Pat K, Walgraeve D, Spaas L, Verheezen J, Verniest T, Goegebuer A, Wildiers H, Tjan-Heijnen V, Buntinx F, Van den Akker M. Study
protocol of KLIMOP: a cohort study on the wellbeing of older cancer patients in Belgium and the Netherlands. BMC Publ Health 2011; 11: 825
Contact:
KLIMOP is funded by VLK, the Flemisch League against Cancer and Interreg IVcross-border region Flanders – the Netherlands