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A B S T R A C T S
with MM3. More CS than CFIs reported fair/poor health (32.9%
and 22.0%). Similarly, 2-year worse health and 2-year mortality
were higher in CS than in CFIs (28.5% vs. 20.5%, and 6.6% vs.
2.7%, respectively). All comparisons were significant at p < 0.02.
Adjusting for MM and other confounders, CS was associated
with a greater likelihood to report fair/poor health (adjusted
Odds Ratio 1.7 (95% confidence interval: 1.5, 2.0), and worse
health in 2 years (1.2 (1.1, 1.4)). Similarly, CS were more likely to
die in the 2 years following interview (1.5 (1.2, 2.0)). The effect
of CS appears to decline with years since diagnosis for fair/poor
health and 2-year mortality, but CS view their health as worse
than CFIs regardless of years since diagnosis.
Conclusion:
CS status is associated with greater MM and
with worse health outcomes, even after adjusting for potential
confounders. Given the increase in CS and their improved life
expectancy, it is important to determine whether CS perceive
worse self-reported due to their past challenges, or whether
it reflects unmeasured conditions, such as fatigue. Remedial
measures can be taken accordingly to improve their health
status.
Reference:
[1] DeSantis CE, et al. Cancer Treatment and Survivorship
Statistics, 2014. CA Cancer J Clin, 2014; 64:252-271.
Disclosure of interest:
D.Warner: None declared, N. Schiltz:
None declared, K. Stange: None declared, C. Given: None
declared, C. Owusu: None declared, N. Berger: None declared,
S. Koroukian Grant/Research Support from: Agency for
Healthcare Research and Quality (R21 HS02113)
Keywords:
Multimorbidity, survivorship
P131
TRAJECTORIES OF FUNCTIONAL LIMITATIONS AND HEALTH
STATUS BY CANCER SURVIVOR STATUS: DOES THE GAP
CLOSE WITH LONGER SURVIVORSHIP?
D. F. Warner
1
, N. K. Scihltz
2
, K. C. Stange
3
, C. Given
4
, C. Owusu
5
,
N. A. Berger
6
, S. M. Koroukian
2,
*
1
Sociology, University of Nebraska, Lincoln,
2
Epidemiology and
Biostatistics,
3
Family Medicine and Community Health, Case
Western Reserve University, Cleveland,
4
Family Medicine,
Michigan State University, East Lansing,
5
Hematology/ Oncology,
6
Hematology/Oncology, University Hospitals of Cleveland/Case
Medical Center, Cleveland, USA
Introduction:
Advances in early cancer detection and
treatment have yielded significant improvements in
survivorship, as attested by the increasing population of
cancer survivors (CS). As of January 1, 2014, there were 14.5
million cancer survivors, and 86% were 50 years of age or
older [1]. As they grow older, CS will experience an increased
likelihood to develop other co-occurring chronic conditions
and/or geriatric syndromes, similar to cancer-free individuals
(CFIs). Given that cancer treatment may be associated with
depletion of health reserves, it is likely that CS will experience
more functional limitations and poorer self-rated health (F/H)
outcomes, especially during the active treatment period and
shortly thereafter.
Objectives:
We examine the differential in F/H outcomes
between CS and CFIs over time, as individuals recover from
the toxic treatment effects.
Methods:
We use self-reported data on 50 to 85 year olds
from the nationally-representative 1992-2012 Health and
Retirement Study (HRS), a biennial panel of older adults age
50 and over. Our focal independent variables are CS status and
years since cancer diagnosis. Our outcomes are functional
limitations (a count of 12 mobility, lower body and upper body
impairments) and self-rated health status (0=“excellent” to
5=“poor”). Controls include socio-demographics, household
income, health insurance coverage, health behaviors (e.g.,
smoking, alcohol use), non-cancer chronic conditions (e.g.,
hypertension, diabetes), geriatric syndromes (e.g., poor
cognitive functioning, sensory impairment), the number of
follow-up interviews, and whether the respondent died during
the panel. In addition to descriptive analysis, we estimated
multivariate random coefficient growth curve models to
examine intra-individual change in F/H outcomes for CS and
CFIs over time, adjusting for potential confounders.
Results:
Our study population included 23,053 individuals
contributing 116,734 observations. 12.1% were CS, 55.5%
were women, and 26.7% were non-white. The median follow
up period was 14 years. While older adults report more
functional limitations and poorer self-rated health with age,
CS had slightly more limitations (intercept (b)=.61, 95% CI
(.41,.82)) and rated their health poorer than similarly aged
CFIs (Adjusted odds ratio=2.56 (2.05, 3.19)), adjusting for
potential confounders. While the gap between CS’ and CFIs’
trajectories reduced over time, it persisted even 10 years after
cancer diagnosis. Although CS had more (non-cancer) chronic
conditions and geriatric syndromes than CFIs, these did not
explain the gaps in F/H outcomes. CS’ greater functional
limitations also did not explain their poorer self-rated health.
Conclusion:
CS status is associated with functional
limitations and poorer self-rated health, even after adjusting
for confounders. Although the effects of cancer on health
outcomes are greatest in the period immediately after
diagnosis, CS continue to have worse health outcomes even
10 years after diagnosis. The gap in F/H outcomes for CS
and CFIs is not due to differences in co-occurring chronic
conditions or geriatric syndromes, nor is it due to differences
in sociodemographic or other characteristics. These results
suggest that cancer survivorship is associated with long-
lasting negative health consequences. Further studies are
needed to examine explanatory factors.
Reference:
[1] DeSantis CE et al. Cancer Treatment and Survivorship
Statistics, 2014. CA Cancer J Clin, 2014; 64: 252-271.
Disclosure of interest:
D. Warner: None declared, N.
Scihltz: None declared, K. Stange: None declared, C. Given:
None declared, C. Owusu: None declared, N. Berger: None
declared, S. Koroukian Grant/Research Support from: Agency
for Healthcare Research and Quality R21 HS023113
Keywords:
Functional limitations, health trajectory,
survivorship