ASCO 2008: Cancer is independent predictor of increased vulnerability in elderly persons

May 31, 2008

Cancer is an independent predictor of increased vulnerability, functional limitations, geriatric syndromes, frailty, and fair or poor health status among older Medicare beneficiaries. "Up until now, a lot of this has been more opinion rather than numbers," said Gary R. Morrow, MD, professor of radiation oncology, University of Rochester Cancer Center. "This gives us a method to let us know if we have changed anything.

Cancer is an independent predictor of increased vulnerability, functional limitations, geriatric syndromes, frailty, and fair or poor health status among older Medicare beneficiaries. "Up until now, a lot of this has been more opinion rather than numbers," said Gary R. Morrow, MD, professor of radiation oncology, University of Rochester Cancer Center. "This gives us a method to let us know if we have changed anything."

Increased vulnerability among the elderly has been associated with a high prevalence of comorbidity, disability, or geriatric syndromes that place them at increased risk for decline or death. However, the impact of cancer on this vulnerability has not been previously well described or studied, researchers said.

Dr. Morrow and colleagues analyzed a sample of 12,480 elders included in the 2003 Medicare Current Beneficiary Survey for differences in comorbidity, disability, and geriatric syndromes between those with cancer and those without. Differences in scores on the Vulnerable Elders Survey-13 (VES-13) were assessed.

There were 2349 (18%) cancer patients in the cohort. Among them there was a 32% deficit in activities of daily living (ADL) with 49% having an instrumental ADL deficit (IADL). A significant comorbidity was observed in 64% and at least one geriatric syndrome (dementia/memory loss, depression, falls, incontinence, or osteoporosis) was present in 68%. The differences in functional deficit, comorbidity and geriatric syndromes was significant compared to those without cancer (p < 0.0001). The mean VES-13 score was significantly higher among cancer patients (p <0.0001).

After adjusting for age and comorbidity, cancer patients were 1.32 times more likely to have an ADL deficit, 1.17 times more likely to have an abnormal VES-13 score, and 1.21 times more likely to have geriatric syndrome. In addition, cancer patients were 1.3 times more likely to have an IADL, 1.5 times more likely to report fair or poor health status, and 1.4 times more likely to be frail (age 85 or more, at least one ADL, three or more chronic medical conditions, presence of geriatric syndromes).

Lung, bladder, and ovarian cancer were independent predictors of ADL deficit. Lung cancer predicted a high VES-13 score, while colon, prostate, and bladder cancer predicted the occurrence of geriatric syndromes.

"Even though the differences are small for individual problems, the aggregate burden is large in cancer patients," the researchers said. "Defining the connections between cancer and vulnerability would identify targets for improving cancer care and quality of life in older people." The VES-13 should be considered a useful tool in future research involving the impact of cancer in these patients, they concluded.