Comorbidities, Functional Limitations, and Geriatric Syndromes in Relation to Treatment and Survival Patterns Among Elders With Colorectal Cancer
Comorbidities, Functional Limitations, and Geriatric Syndromes in Relation to Treatment and Survival Patterns Among Elders With Colorectal Cancer
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DOI：
10.1093/gerona/glp180
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发表时间：
2010-03-01
影响因子：
5.1
通讯作者：
Owusu, Cynthia
中科院分区：
文献类型：
--
作者：
Koroukian, Siran M.;Xu, Fang;Owusu, Cynthia
目的.研究结直肠癌（CRC）治疗模式和生存率与合并症（COM）、功能受限（FL）和老年综合征（GS）的关系。我们的研究人群包括1999年8月至2001年11月期间诊断为偶发浸润性CRC的俄亥俄州老年人，并在癌症诊断前后30天内接受家庭保健（HHC）（n = 1009）。我们使用了来自俄亥俄州癌症发病率监测系统、生命记录和医疗保险管理数据的数据，包括HHC结局和评估信息集（OASIS），其中包括HHC患者的详细临床数据。从OASIS中检索基线时COM、FL和GS的计数。多变量逻辑斯谛和生存模型被开发来检查临床属性和结果之间的关联，调整人口统计学协变量和癌症分期。合并症与仅手术的可能性增加相关，但与手术+化疗无关。FL和GS均与仅接受手术或手术+化疗的可能性较低相关。两种或两种以上GS与疾病特异性死亡率（校正风险比[AHR]：2.71; 95%置信区间[CI]：1.80-4.07）和总体死亡率（AHR：2.34; 95% CI：1.74-3.15）相关。两个或两个以上FL与总死亡率相关（AHR：1.33; 95% CI：1.10-1.62），但与疾病特异性死亡率无关。COM与总死亡率无关，但与疾病特异性死亡率呈显著负相关（AHR：0.7895%CI：0.61-1.00）。我们的研究结果表明，在研究老年人癌症相关结果时，除了COM外，还应考虑FL和GS。
Purpose. To examine patterns of colorectal cancer (CRC) treatment and survival in relation to comorbidities (COM), functional limitations (FL), and geriatric syndromes (GS).Methods. Our Study population consisted of Ohio elders diagnosed with incident invasive CRC in the period August 1999 to November 2001 and admitted to home health care (HHC) in the 30 days before or after cancer diagnosis (n = 1009). We used data from the Ohio Cancer Incidence Surveillance System, vital records, and Medicare administrative data, including the HHC Outcome and Assessment Information Set (OASIS), which includes detailed clinical data for HHC patients. Counts of COM, FL, and GS at baseline were retrieved from the OASIS. Multivariable logistic and survival models were developed to examine the association between clinical attributes and outcomes, adjusting for demographic covariates and cancer stage.Results. Comorbidities were associated with increased likelihood of surgery-only, but not with surgery + chemotherapy. Both FL and GS were associated with lower likelihood to undergo surgery-only or surgery + chemotherapy. Two or more GS was associated with disease-specific mortality (adjusted hazard ratio [AHR]: 2.71; 95% confidence interval [CI]: 1.80-4.07) and overall mortality (AHR: 2.34; 95% CI: 1.74-3.15). Two or more FL was associated with overall mortality (AHR: 1.33; 95% CI: 1.10-1.62), but not with disease-specific mortality. COM was not associated with overall mortality, but was negatively associated with disease-specific mortality at borderline level of significance (AHR: 0.78 95% CI: 0.61-1.00).Conclusion. Our findings demonstrate the importance of accounting for FL and GS, in addition to COM, when studying cancer-related outcomes in elders.