Kenzik Kelly M, Kent Erin E, Martin Michelle Y, Bhatia Smita, Pisu Maria
Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, 35233, USA.
Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
J Cancer Surviv. 2016 Dec;10(6):1096-1103. doi: 10.1007/s11764-016-0553-4. Epub 2016 May 27.
The purpose of the study is to identify chronic condition clusters at pre- and post-cancer diagnosis, evaluate predictors of developing clusters post-cancer, and examine the impact on functional impairment among older cancer survivors.
We identified 5991 survivors age 65 and older of prostate, breast, colorectal, lung, bladder, kidney, head and neck, and gynecologic cancer and non-Hodgkin lymphoma from the Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey resource. Survivors completed surveys pre- and post-cancer diagnosis on 13 chronic conditions and functional status. Among those with ≥2 conditions, exploratory factor analysis identified clusters of conditions. Differences in cluster frequency from pre- to post-cancer diagnosis were evaluated across the top five cancer types using chi-square tests. Modified Poisson regression models estimated the relative risk of developing clusters post-diagnosis. Chi-square tests evaluated associations between function and clusters.
Clusters included the following: cardiovascular disease cluster (pre 6.1 % and post 7.7 %), musculoskeletal cluster (28.2 % and 29.3 %), metabolic cluster (14.9 % and 17.6 %), and the major depressive disorder risk (MDDr) + gastrointestinal (GI) + pulmonary condition cluster (5.8 % and 8.7 %). Increases in MDDr + GI + Pulmonary cluster from pre- to post-cancer diagnosis were observed for prostate, lung, and colorectal cancer survivors. Functional impairment was more prevalent in survivors with defined clusters, especially in MDDr + GI + pulmonary, compared to survivors with ≥2 un-clustered conditions.
Distinct condition clusters of two or more chronic conditions are prevalent among older cancer survivors. Cluster prevalence increases from pre- to post-cancer diagnosis and these clusters have a significant impact on functional limitations.
Tailored management on specific multimorbidity patterns will have implications for functional outcomes among older survivors.
本研究旨在确定癌症诊断前后的慢性病集群，评估癌症后出现集群的预测因素，并研究其对老年癌症幸存者功能损害的影响。
我们从监测、流行病学和最终结果-医疗保险健康结果调查资源中识别出5991名年龄在65岁及以上的前列腺癌、乳腺癌、结直肠癌、肺癌、膀胱癌、肾癌、头颈癌、妇科癌症和非霍奇金淋巴瘤幸存者。幸存者在癌症诊断前后完成了关于13种慢性病和功能状态的调查。在患有≥2种疾病的人群中，探索性因素分析确定了疾病集群。使用卡方检验评估了前五位癌症类型中癌症诊断前后集群频率的差异。修正泊松回归模型估计了诊断后出现集群的相对风险。卡方检验评估了功能与集群之间的关联。
集群包括以下几种：心血管疾病集群（诊断前6.1%，诊断后7.7%）、肌肉骨骼集群（28.2%和29.3%）、代谢集群（14.9%和17.6%）以及重度抑郁症风险（MDDr）+胃肠道（GI）+肺部疾病集群（5.8%和8.7%）。前列腺癌、肺癌和结直肠癌幸存者在癌症诊断前后MDDr+GI+肺部集群有所增加。与患有≥2种未聚类疾病的幸存者相比，明确聚类的幸存者中功能损害更为普遍，尤其是在MDDr+GI+肺部集群中。
两种或更多慢性病的不同疾病集群在老年癌症幸存者中普遍存在。从癌症诊断前到诊断后，集群患病率增加，这些集群对功能限制有显著影响。
针对特定多重疾病模式的定制管理将对老年幸存者的功能结局产生影响。
