The impact of cancer on survivors: data from a large national sample of older adults Don Baken, PhD Massey University Oncology Service

Acknowledgements Health, Work & Retirement Study –School of Psychology, Massey University –Centre for Maori Health Research and Development, in the School of Maori Studies (Te Putahi-a-Toi), Massey University –New Zealand Institute for Research on Ageing HRC Cancer Society Denise Robbins

Health Work and Retirement Study Nationally representative Longitudinal 2006, 2008, 2010, ??? Equal probability sampling for both general and Maori samples Over sampled for Maori High response rate Over 2,000 respondents Aged 55-70

Health Work and Retirement Study 2008 Nationally representative Cross sectional Over 2,000 respondents Aged (mean about 64 ) Statistical weighting used to address inconsistencies in selection and response in regard to age, gender, ethnicity

Demographics No CancerCancer Age – (4.65) Sex – 50.3% female N = (4.31) 55.4% 268 In TxPost Tx (3.93) 44.2% (4.43) 55.6% Yrs5+ Yrs (4.79) 51.6% (4.47) 58.3% 102

Areas QoL Medical Work Finances

SF 36 PCS –Overall assessment of physical health Considers ability to perform behaviours MCS –Overall assessment of mental health Psychological wellbeing Social and role functioning Overall vitality

QoL SF36 PCS No CancerCancerSig (9.36) (11.18).000 In TxPost Tx (12.50)47.77 (10.57) Yrs5+ Yrs (12.60)49.60 (9.33).087

QoL SF36 MCS No CancerCancerSig (9.37) (9.79).027 In TxPost Tx (11.36)50.10 (8.72) Yrs5+ Yrs (9.27)49.78 (9.15).615

Other Chronic Conditions SF36 -PCSSF36-MCS Asthma (341)43.6 (10.8)46.3 (11.3) Other respiratory conditions (249) 41.9 (10.9)45.6 (11.8) Arthritis or rheumatism (675) 42.9 (10.2)47.7 (10.9) Stroke (78)40.8 (12.4)43.7 (12.3) Depression (198)45.2 (11.1)38.9 (12.4) ME/CFS (26)36.2 (9.6)37.5 (13.2)

Prevalence of distress in the RCTS region Sample: 400 patients Response rate: 50% Questionnaire: –CRDSA –HADS –Demographics

Stage in the Journey Diagnosis16.6% Treatment 35.9% Post Treatment35.9% Advanced Disease 11.6%

Prevalence HADS Anxiety HADS Depression BSI-18 Distress Overall27.2 %20.3 %34.3 % Diagnosis28.0 %20.0 %36.9 % Treatment30.8 %22.2 %39.3 % Post treatment 26.0 %12.3 %30.9 % Advanced Disease 33.5 %52.4 %44.4 %

HWR Medical

GP Visits in the last 12 months (1=1, 2=2, 3=3-5, 4=6-11, & 5=12+) No CancerCancerSig (0.94) 2.89 (1.00).000 In TxPost Tx 3.23 (1.01) *12.81 (0.96) * Yrs5+ Yrs 2.95 (1.21)2.80 (0.90).036

Prescriptions No CancerCancerSig (2.64) 2.82 (2.85).236 In TxPost Tx 4.11 (4.13)2.77 (2.61) Yrs5+ Yrs 2.63 (3.16)2.48 (2.18).945

I avoid unhealthy behaviours No CancerCancerSig (1.37) 4.20 (1.24).120 In TxPost Tx 4.12 (1.33)4.18 (1.27) Yrs5+ Yrs 3.68 (1.67)4.47 (0.95).042

Excess Alcohol Use No CancerCancerSig (2.50) 2.78 (2.21).014 In TxPost Tx 2.81 (2.22)2.88 (2.28) Yrs5+ Yrs 3.11 (2.16)2.76 (2.19).295

Employment

Employment Status: Current % No CancerIn Tx1-2 Yrs5+ Full-time Part-time Retired Unable to Work

Employment Status: Current [Preferred] % No CancerIn Tx1-2 Yrs5+ Full-time 40.7 [24.1]18.6 [8.6]41.9 [26.3]32.8 [15.6] Part-time 24.5 [44.7]32.2 [61.6]10.4 [25.4]29.1 [55.6] Retired 25.7 [25.4]37.6 [15.6]39.6 [46.2]29.9 [21.4] Unable to work 4.2 [1.0]11.1 [6.5]8.2 [0.6]4.5 [1.6]

% forced to retire due to ill health No CancerCancer 7.4% 17.5% In TxPost Tx 27.1%14.6% 1-2 Yrs5+ Yrs 8.5%14.5%

Job Satisfaction No CancerCancerSig (9.25) (8.85).713 In TxPost Tx (9.51)69.02 (8.60) Yrs5+ Yrs (8.83)68.38 (8.41).482

Finances

My income meets my needs No CancerCancerSig (0.92) 2.55 (0.89).323 In TxPost Tx 2.31 (0.91)2.59 (0.89) Yrs5+ Yrs 2.57 (1.07)2.70 (0.88).530

I am satisfied with my standard of living No CancerCancerSig (0.82) 1.98 (.73).536 In TxPost Tx 1.98 (0.74)1.92 (0.73) Yrs5+ Yrs 1.85 (0.43)1.90 (0.78).704

By the time I retire I will have enough money No CancerCancerSig (1.40) 2.97 (1.43).295 In TxPost Tx 3.18 (1.58)2.95 (1.41) Yrs5+ Yrs 3.04 (1.86)3.04 (1.33).951

I worry about the std of living I will have at retirement No CancerCancerSig (1.25) 3.27 (1.31).931 In TxPost Tx 3.65 (1.32)3.12 (1.34) Yrs5+ Yrs 3.30 (1.48)3.15 (1.37).719

Maori Lower on the variables that are usual (e.g. QOL, job satisfaction, etc). Less reported social support But no interaction with cancer

Limitations/considerations HWR a representative sample? Limited by what HWR decide to measure Cross sectional Coarse analysis –Have not been able to consider cancer type/site/stage etc

Summary On going impact on Physical QoL Anxiety and Depression for some Medical costs? Significant work/career disruption Not all survivors struggle We need to indentify those that do

Questions Is Mental QoL sustained by their manipulation of work status? Can we avoid the work/career loss/disruption and/or speed up the transition back to work? How do we identify those survivors that are significantly impacted.