Galvin Angéline, Helmer Catherine, Coureau Gaëlle, Amadeo Brice, Joly Pierre, Sabathé Camille, Monnereau Alain, Baldi Isabelle, Rainfray Muriel, Soubeyran Pierre, Delva Fleur, Mathoulin-Pélissier Simone
Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, F-33000 Bordeaux, France.
Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Leha team, UMR 1219, F-33000 Bordeaux, France.
Cancer Epidemiol. 2018 Aug;55:39-44. doi: 10.1016/j.canep.2018.04.013. Epub 2018 May 25.
Several studies have reported disparities in the care management and survival of older cancer patients. The aim of our study was to identify determinants of treatment administration in this population of cancer patients aged over 65 years taking into account competing risks of death.
The INCAPAC study is a population-based study. Four cancer registries and three prospective cohort studies on older subjects (age ≥65 years) from Gironde, a French department, were merged to identify older cancer patients. We used a non-parametric multi-state model including three states (cancer, treatment and all-cause death). This model allowed studying determinants of treatment administration (all treatments including curative, symptomatic and palliative treatments) and mortality considering that patients can move from cancer state to death state, either directly or through the treatment phase. Studied variables were demographic and socioeconomic-, cancer-, health-, and geriatric-related.
A total of 450 patients were included in the analyses. They were mainly aged 85 and over, men and educated. Among included patients, 372 (83%) received cancer treatment. In the final multivariate model, dementia was associated with a lower likelihood of receiving cancer treatment (HR = 0.68, 95% CI = 0.47-0.99). In treated patients, age, sex, comorbidities, dependency and stage at diagnosis were associated to all-cause mortality, and in untreated patients, diagnosis of dementia and stage at diagnosis were associated to mortality.
Further studies are necessary to understand the impact of geriatric impairments on treatment administration and to develop clinical practice guidelines.
多项研究报告了老年癌症患者在护理管理和生存方面的差异。我们研究的目的是确定65岁以上癌症患者群体中治疗实施的决定因素，并考虑到死亡的竞争风险。
INCAPAC研究是一项基于人群的研究。将来自法国吉伦特省的四个癌症登记处和三项关于老年受试者（年龄≥65岁）的前瞻性队列研究合并，以确定老年癌症患者。我们使用了一个非参数多状态模型，包括三个状态（癌症、治疗和全因死亡）。该模型允许研究治疗实施（包括根治性、对症和姑息性治疗在内的所有治疗）的决定因素以及死亡率，因为患者可以直接或通过治疗阶段从癌症状态转移到死亡状态。研究的变量包括人口统计学和社会经济、癌症、健康和老年相关变量。
共有450名患者纳入分析。他们主要为85岁及以上的男性且受过教育。纳入的患者中，372名（83%）接受了癌症治疗。在最终的多变量模型中，痴呆与接受癌症治疗的可能性较低相关（HR = 0.68，95% CI = 0.47 - 0.99）。在接受治疗的患者中，年龄、性别、合并症、依赖性和诊断时的分期与全因死亡率相关，而在未接受治疗的患者中，痴呆诊断和诊断时的分期与死亡率相关。
有必要进行进一步研究以了解老年功能障碍对治疗实施的影响，并制定临床实践指南。
