Pergolotti Mackenzi, Deal Allison M, Lavery Jessica, Reeve Bryce B, Muss Hyman B
Cancer Care Quality Training Program, Department of Health Policy and Management, 1102G McGavran-Greenberg Hall, CB# 7411, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Biostatistics and Clinical Data Management Core, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, 450 West Drive, CB#7295, Chapel Hill, NC 27599, USA.
J Geriatr Oncol. 2015 May;6(3):194-201. doi: 10.1016/j.jgo.2015.01.004. Epub 2015 Jan 19.
Occupational and physical therapy (OT/PT) services seek to reduce morbidity, mortality, and improve the quality of life of individuals; however, little is known about the needs and use of OT/PT for older adults with cancer. The goal of this study was to describe the functional deficits and their associations with other factors, and to examine the use of OT/PT after a noted functional deficit.
This study analyzed data from an institution-based registry that included geriatric assessments of older adults with cancer linked to billing claims data. Logistic regression was used to model predictors of functional deficits. Use of OT/PT was determined and validated with medical chart review.
529 patients with cancer, a median age of 71, 78% were female, 87% Caucasian, 57% married, 53% post-secondary education, and 63% with breast cancer were included. In a multivariable model, the odds of having any functional deficits increased with age [5 year OR: 1.31, 95% CI: (1.10, 1.57)] were higher for those with a high school diploma versus those with advanced degrees [OR: 1.66, 95% CI: (1.00, 2.77)] and were higher for patients with comorbidities [OR: 1.15, 95% CI: (1.10, 1.21)]. Of patients with functional deficits only 9% (10/111) received OT/PT within 12 months of a noted deficit.
The odds of having any potentially modifiable functional deficit were higher in patients with increasing age, comorbid conditions, and with less than a college degree. Few were referred for OT/PT services suggesting major underutilization of these potentially beneficial services.
职业治疗和物理治疗(OT/PT)服务旨在降低发病率、死亡率并改善个体生活质量;然而,对于患有癌症的老年人对OT/PT的需求和使用情况知之甚少。本研究的目的是描述功能缺陷及其与其他因素的关联,并在发现功能缺陷后检查OT/PT的使用情况。
本研究分析了来自一个基于机构的登记处的数据,该数据包括对患有癌症的老年人的老年评估以及相关的计费索赔数据。采用逻辑回归对功能缺陷的预测因素进行建模。通过病历审查确定并验证OT/PT的使用情况。
纳入了529例癌症患者,中位年龄为71岁,78%为女性,87%为白种人,57%已婚,53%具有大专以上学历,63%患有乳腺癌。在多变量模型中,出现任何功能缺陷的几率随年龄增加而增加[5年比值比:1.31,95%置信区间:(1.10,1.57)],高中文凭者比具有高等学位者出现功能缺陷的几率更高[比值比:1.66,95%置信区间:(1.00,2.77)],合并症患者出现功能缺陷的几率更高[比值比:1.15,95%置信区间:(1.10,1.21)]。在出现功能缺陷的患者中,只有9%(10/111)在发现缺陷后的12个月内接受了OT/PT治疗。
年龄增加、患有合并症以及学历低于大学的患者出现任何潜在可改变的功能缺陷的几率更高。很少有人被转介接受OT/PT服务,这表明这些潜在有益的服务存在严重利用不足的情况。