Ouderen en kanker in Limburg Frank Buntinx, Laura Deckx, Marjan Van den Akker Gerionne 9.11.2011

Analysis of the RNH and Intego databases: prevalent and subsequent co-morbidity in cancer and non-cancer patients. KLIMOP: a cohort study on cancer in older cancer patients.

Co-morbidity

Co-morbidity in cancer and non-cancer patients RNH: GP-based database. ‘serious’ morbidity of 131.920 patients , 69 GPs in Limburg. Included: all cancer cases diagnosed between 1998-2007, all skin cancers excluded. Prevalent co-morbidity: cross-sectional design. Subsequent morbidity: (retrospective) cohort design, FU=6 months to 5 years after diagnosis. 3.544 cancer patients, 11.060 non-cancer patients, matched on age, sex and practice. If applicable, the last three months before death were excluded.

Pre-existing (Men)

Pre-existing (Women)

Pre-existing (men) - categories

Subsequent (men) - categories

Subsequent (men) - CVD

Subsequent (men) 10 most common diseases

Subsequent (women) - CVD

KLIMOP What is the influence of a cancer diagnosis, ageing and the interaction between them on general wellbeing of older patients?

Influence of cancer diagnosis, ageing & their interaction on general wellbeing Co-morbidity ADL, IADL, cognition, depression, Quality of life Loneliness & social network Ageing: Age (years)? Frailty? Telomere length? Immunological ageing?

Older patients without any previous cancer diagnosis (≥ 70 jaar) Design Young cancer patients (50 - 69 years) Primary diagnosis of breast, lung, prostate or gastro-intestinal cancer Older cancer patients (≥ 70 years) Primary diagnosis of breast, lung, prostate or gastro-intestinal cancer Older patients without any previous cancer diagnosis (≥ 70 jaar) Ageing Cancer

Older cancer patients (≥ 70 y) Younger cancer patients (50 – 69 y) Carers Older cancer patients (≥ 70 y) Younger cancer patients (50 – 69 y) Older non-cancer patients (≥ 70 y) Baseline 6 months 1 year 2 years … Interview Info from medical files 2 samples of cheek mucosa (questionnaire carers)

KLIMOP: inclusion Aim: 2 x 375 per group Baseline 6 months 1 year Younger cancer patients (50 – 69 years) 137 62 15 Older cancer patients (≥ 70 years) 78 28 3 Older non-cancer patients (≥ 70 years) 130 75 14 Totaal 345 165 32 Aim: 2 x 375 per group

Older non-cancer patients Baseline Young cancer patients (50 – 69 y) Older cancer patients (≥ 70 y) Older non-cancer patients Age(mean, SD) 60.54 (5.41) 76.88 (4.95) 78.32 (5.44) Gender: - male 38 (28%) 30 (38%) 50 (38%) - female 99 (72%) 48 (62%) 80 (62%) Global Qol (mean, SD) 68.79 (19.18) 63.58 (23.39) 73.03 (19.26) ADL: - Completely independent 72 (52%) 35 (47%) 37 (32%) - Reasonably independent 63 (46%) 32 (43%) 67 (57%) - Some aid necessary 1 (1%) 5 (7%) 10 (9%) - Serious need for help 3 (4%) 3 (3%) - Completely dependent Total 137 78 130 ADL: * 0 - 4 volledig hulpbehoevend * 5-9 ernstig hulpbehoevend * 10-14: heeft wel hulp nodig maar doet ook veel zelf * 15-19 redelijk tot goed zelfstandig * 20: volledig zelfstandig

Older non-cancer patients Baseline Young cancer patients (50 – 69 y) Older cancer patients (≥ 70 y) Older non-cancer patients IADL: - Independent 113 (83%) 48 (62%) 59 (45%) - Limited in 1 or more domains 24 (18%) 30 (38%) 71 (54%) GDS-15 - Normal 113 (82%) 54 (69%) 101 (78%) - Depressive feelings 24 (31%) 29 (22%) MMSE: Normal 128 (94%) 66 (85%) 110 (85%) Impaired 8 (6%) 12 (15%) 19 (15%) Totaal 137 77 130 IADL: women (score between 0 – 8) GDS-15: 0 - 4 = normal, ≥ 5 depressive feelings IADL: men (score between 0 – 6, extra question on reparations added) MMSE: normal (30 – 25), impaired(≤ 24)

Loneliness Loneliness* Yes (%) No Total Younger cancer patients 16 (15) 105 124 Older cancer patients 26 (39) 40 66 Older non-cancer patients 49 (49) 70 119 *: loneliness scale of De Jong-Gierveld most lonely patients were slightly lonely (only 8 scored > 8/11) Significant positive relation with QoL in both groups of cancer patients Significant relation with functional status (limited in > 2 domains): significant in older cancer patients only: OR= 4,3 (1,3-13,7) Relation with living situation (with others – alone) not significant

Baseline Depression ~ Fatigue* Normal Depression (≥ 5) T-test N Mean (SD) P-value Younger cancer patients Fatigue 113 21.53 (24.72) 23 36.71 (31.32) 0.01 Older cancer patients 54 27.98 (25.33) 21 48.41 (28.93) 0.00 Older non-cancer patients 101 23.82 (21.29) 28 40.87 (29.01) * Fatigue is measured with the EORTC QLQ-C30 subscale. A higher score means more (max = 100)

Global Quality of life: Baseline ~ 6 months Worsening (>10%) No change Improvement (>10%) Younger cancer patients QoL: 22 (36%) 12 (20%) 27 (44%) Older cancer patients 14 (52%) 6 (22%) 7 (26%) Older non-cancer patients 17 (23%) 30 (41%) 27 (36%) Depression: no significant differences Cognition: no significant differences n=165

Fatigue: Baseline ~ 6 months Worsening (>10%) No change Improvement (>10%) Younger cancer patients Fatigue 34 (56%) 18 (30%) 9 (15%) Older cancer patients 10 (37%) 14 (52%) 3 (11%) Older non-cancer patients 23 (31%) 28 (38%) Chemotherapy? P=0.01 (worsening – no worsening) n = 162

Deckx L, Van Abbema D, Nelissen K, Daniels L, Stinissen 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, Buntinx F, Van den Akker M, Research group on older cancer patients. Study protocol of KLIMOP: a cohort study on the wellbeing of older cancer patients in Belgium and the Netherlands. BMC Publ Health 2011; 11: 825 contact: laura.deckx@med.kuleuven.be - doris.van.abbema@mumc.nl