Download KLIMOP: a cohort study on the wellbeing of older cancer patients

12/11/13 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. Bun<nx and Dr. Bulens a?er a study performed by LIKAS in 2007 among stakeholders •  “Cancer in Limburg: Challenges and strategic op<ons for a coordinated approach “ •  This study showed that the challenges in cancer care will be: –  The psychosocial aspects of cancer care –  Scien<fic research for older cancer pa<ents 1 12/11/13 Survival: quantity or quality? •  Survival: quan,ty –  Survival of cancer pa<ents increases –  Not for older cancer pa<ents: 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 interac<on on subsequent wellbeing of older cancer pa<ents Comorbidity Func,onal status Depression Quality of life 2 12/11/13 Inclusion (January 2011) Baseline 6 months 1 year Younger cancer pa<ents 168 84 30 Older cancer pa<ents 100 44 7 Older pa<ents without cancer 157 84 25 Total interviewed 425 212 62 Lost to follow-­‐up / 40 4 Deceased / 14 3 ... Comorbidity Func,onal status Depression Quality of life 3 12/11/13 Comorbidity •  Comorbidity: the co-­‐occurence of different diseases •  Comorbidity is an enormous problem (Marengoni 2011) –  Highly prevalent (55% -­‐ 98%) –  Cause of disability, func<onal impairment, low Qol, high health care costs –  Survival Comorbidity Number of chronic diseases (addi,onal to cancer) 30 25 20 % 15 10 5 0 0 1 Cancer pa<ents (60+) 2 3 ≥ 4 Non-­‐cancer pa<ents (60+) Guidelines to for the treatment of cancer pa,ents with comorbidity are lacking! (Signaleringscommissie Kanker van KWF Kankerbestrijding 2011) 4 12/11/13 Comorbidity Func,onal status Depression Quality of life Functional status •  Maintenance of independence is very important •  Associated with survival •  Cancer pa<ents have more func<onal problems (Hewik 2003, Kea<ng 2005) •  Likle prospec<ve studies that inves<gate the risk factors for func<onal decline in older cancer pa<ents → Cave! Selec<on of par<cipants 5 12/11/13 Functional status* : Baseline ~ 6 months Worse Idem BeKer Baseline N (%) N (%) N (%) Impaired 16 (10%) 39 (46%) 37 (44%) 8 (10%) Not impaired 152 (90%) 12 (27%) 21 (48%) 11 (25%) 17 (20%) 53 (63%) 14 (17%) Younger cancer pa,ents Older cancer pa,ents Impaired 23 (23%) Not impaired 77 (77%) Older pa,ents without cancer Impaired 45 (19%) Not impaired 112 (71%) *Func<onal status (ADL en IADL): Computed as described by Kellen et al. 2010 Baseline Functional status* ~ Loneliness Impaired Not impaired N N OR 95% CI 2.2 0.6 – 7.8 4.4 1.4 – 14.0 1.2 0.6 – 2.5 Younger cancer pa,ents Lonely 27 (18%) 4 23 Not lonely 124 (82%) 9 115 Lonely 26 (35%) 10 16 Not lonely 48 (65%) 6 42 Lonely 56 (38%) 17 39 Not lonely 91 (62%) 24 67 Older cancer pa,ents Older pa,ents without cancer *Func<onal status (ADL en IADL): Computed as described by Kellen et al. 2010 6 12/11/13 Comorbidity Func,onal status Depression Quality of life 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 7 12/11/13 Depression: Baseline ~ 6 months Worse (>10%) Idem BeKer (>10%) Baseline N (%) N (%) N (%) 12 (8%) 11 (15%) 44 (59%) 20 (27%) 5 (18%) 18 (64%) 5 (18%) 8 (11%) 51 (71%) 13 (18%) Younger cancer pa,ents Depressive feelings No depressive feelings 139 (92%) Older cancer pa,ents Depressive feelings 11 (14%) No depressive feelings 66 (86%) Older pa,ents without cancer Depressive feelings 18 (12%) No depressive feelings 133 (88%) Baseline Depression ~ Loneliness GDS-­‐15 ≥ 5 GDS-­‐15 < 5 N N OR 95% CI 4.8 1.3 – 17.1 8.6 1.6 – 45.2 9.9 2.7 – 36.4 Younger cancer pa,ents Lonely 25 (17%) 5 20 Not lonely 120 (83%) 6 114 Lonely 25 (35%) 7 18 Not lonely 46 (65%) 2 44 Lonely 55 (38%) 14 41 Not lonely 90 (62%) 3 87 Older cancer pa,ents Older pa,ents without cancer 8 12/11/13 Comorbidity Func,onal status Depression Quality of life Quality of life •  What is the impact of cancer, cancer treatment, ageing and their interac<on on Qol? –  Results are inconclusive •  Methodological shortcomings (Joly 2007) –  Cross-­‐sec<onal –  Presenta<on of mean values! –  Prospec<ve but Qol measured only once –  Selec<on of pa<ents 9 12/11/13 Global Qol: Baseline ~ 6 months Worse (>10%) Idem BeKer (>10%) N (%) N (%) N (%) 31 (38%) 15 (19%) 35 (43%) 18 (55%) 8 (24%) 7 (21%) 17 (21%) 35(43%) 30 (37%) Younger cancer pa,ents Global Qol Older cancer pa,ents Global Qol Older pa,ents without cancer Global Qol Comorbidity Func,onal status Depression Quality of life 10 12/11/13 Wellbeing Likle is known about the Comorbidity Func,onal status interac<on between the co-­‐occurrence of -­‐  Comorbidity Depression Quality of life -­‐  Func<onal impairment -­‐  Geriatric syndromes (Koroukian 2011 JCO) Preliminary conclusions •  Results are preliminary and cross-­‐sec<onal! The longer the dura<on 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 pa<ents with mul<morbidity are needed, taking into account: –  Co-­‐morbidity/func<onal impairment/… –  Consequences of cancer treatment –  Collabora<on between different disciplines in primary and secondary care 11 12/11/13 Take home message •  Be cri<cal! –  Was the study popula<on appropriate? –  Cross-­‐sec<onal design versus prospec<ve design? •  Older cancer pa<ents –  Heterogeneous group –  Specific health care needs •  Quality rather than quan<ty 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 KLIMOP is funded by VLK, the Flemisch League against Cancer and Interreg IV cross-­‐border region Flanders – the Netherlands Contact: [email protected] [email protected] [email protected] www.ouderenenkanker.be Deckx L, Van Abbema D, Nelissen K, Daniels L, S<nissen 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, Bun<nx F, Van den Akker M. Study protocol of KLIMOP: a cohort study on the wellbeing of older cancer pa<ents in Belgium and the Netherlands. BMC Publ Health 2011; 11: 825 12