Angéline Galvin1, Catherine Helmer2, Gaëlle Coureau3, Brice Amadeo4, Pierre Joly5, Camille Sabathé5, Alain Monnereau6, Isabelle Baldi7, Muriel Rainfray8, Pierre Soubeyran9, Fleur Delva3, Simone Mathoulin-Pélissier10. 1. Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, F-33000 Bordeaux, France. Electronic address: angeline.galvin@u-bordeaux.fr. 2. Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Leha team, UMR 1219, F-33000 Bordeaux, France. 3. Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, F-33000 Bordeaux, France; Department of Public Health, Bordeaux University Hospital, F-3300 Bordeaux, France. 4. Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, F-33000 Bordeaux, France. 5. Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Biostatistics team, UMR 1219, F-33000 Bordeaux, France. 6. Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, F-33000 Bordeaux, France; Gironde registry of haematological malignancies, Institut Bergonié, F-33000 Bordeaux, France. 7. Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, F-33000 Bordeaux, France; Gironde registry of central nervous system tumors, F-33000 Bordeaux, France; Department of occupational medicine and occupational pathology, Bordeaux University Hospital, F-3300 Bordeaux, France. 8. Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, F-33000 Bordeaux, France; Department of Clinical Gerontology, Bordeaux University Hospital, F-33604 Pessac, France. 9. Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Vinco team, UMR 1218, F-33000 Bordeaux, France; Department of Medical Oncology, SIRIC Bordeaux Research Integrate Oncology, Institut Bergonié, F-33000 Bordeaux, France. 10. Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, F-33000 Bordeaux, France; Clinical and Epidemiological Research Unit, INSERM CIC1401, Institut Bergonié, Comprehensive Cancer Center, F-33000 Bordeaux, France.
Abstract
INTRODUCTION: Several studies have reported disparities in the care management and survival of older cancer patients. The aim of our study was to identify determinants of treatment administration in this population of cancer patients aged over 65 years taking into account competing risks of death. METHODS: The INCAPAC study is a population-based study. Four cancer registries and three prospective cohort studies on older subjects (age ≥65 years) from Gironde, a French department, were merged to identify older cancer patients. We used a non-parametric multi-state model including three states (cancer, treatment and all-cause death). This model allowed studying determinants of treatment administration (all treatments including curative, symptomatic and palliative treatments) and mortality considering that patients can move from cancer state to death state, either directly or through the treatment phase. Studied variables were demographic and socioeconomic-, cancer-, health-, and geriatric-related. RESULTS: A total of 450 patients were included in the analyses. They were mainly aged 85 and over, men and educated. Among included patients, 372 (83%) received cancer treatment. In the final multivariate model, dementia was associated with a lower likelihood of receiving cancer treatment (HR = 0.68, 95% CI = 0.47-0.99). In treated patients, age, sex, comorbidities, dependency and stage at diagnosis were associated to all-cause mortality, and in untreated patients, diagnosis of dementia and stage at diagnosis were associated to mortality. CONCLUSION: Further studies are necessary to understand the impact of geriatric impairments on treatment administration and to develop clinical practice guidelines.
INTRODUCTION: Several studies have reported disparities in the care management and survival of older cancerpatients. The aim of our study was to identify determinants of treatment administration in this population of cancerpatients aged over 65 years taking into account competing risks of death. METHODS: The INCAPAC study is a population-based study. Four cancer registries and three prospective cohort studies on older subjects (age ≥65 years) from Gironde, a French department, were merged to identify older cancerpatients. We used a non-parametric multi-state model including three states (cancer, treatment and all-cause death). This model allowed studying determinants of treatment administration (all treatments including curative, symptomatic and palliative treatments) and mortality considering that patients can move from cancer state to death state, either directly or through the treatment phase. Studied variables were demographic and socioeconomic-, cancer-, health-, and geriatric-related. RESULTS: A total of 450 patients were included in the analyses. They were mainly aged 85 and over, men and educated. Among included patients, 372 (83%) received cancer treatment. In the final multivariate model, dementia was associated with a lower likelihood of receiving cancer treatment (HR = 0.68, 95% CI = 0.47-0.99). In treated patients, age, sex, comorbidities, dependency and stage at diagnosis were associated to all-cause mortality, and in untreated patients, diagnosis of dementia and stage at diagnosis were associated to mortality. CONCLUSION: Further studies are necessary to understand the impact of geriatric impairments on treatment administration and to develop clinical practice guidelines.
Authors: Anna-Maria Goebel; Astrid K Gnekow; Daniela Kandels; Olaf Witt; Rene Schmidt; Pablo Hernáiz Driever Journal: J Cancer Date: 2019-10-17 Impact factor: 4.207