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

2. 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.

3. Co-morbidity

4. Co-morbidity in cancer and non-cancer patients
RNH: GP-based database. ‘serious’ morbidity of patients , 69 GPs in Limburg.
Included: all cancer cases diagnosed between , 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, non-cancer patients, matched on age, sex and practice.
If applicable, the last three months before death were excluded.

5. Pre-existing (Men)

6. Pre-existing (Women)

7. Pre-existing (men) - categories

8. Subsequent (men) - categories

9. Subsequent (men) - CVD

10. Subsequent (men) 10 most common diseases

11. Subsequent (women) - CVD

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

13. 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?

14. Older patients without any previous cancer diagnosis (≥ 70 jaar)
Design
Young cancer patients ( 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

15. 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)

16. 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

17. 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: * volledig hulpbehoevend * 5-9 ernstig hulpbehoevend * 10-14: heeft wel hulp nodig maar doet ook veel zelf
* redelijk tot goed zelfstandig * 20: volledig zelfstandig

18. 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: = normal, ≥ 5 depressive feelings
IADL: men (score between 0 – 6, extra question on reparations added)
MMSE: normal (30 – 25), impaired(≤ 24)

19. 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

20. 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)

21. 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

22. 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

23. 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
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