The Ohio State University Comprehensive Cancer Center/The James Cancer Hospital & Solove Research Institute, B424 Starling Loving Hall, 320 W. 10th Avenue, Columbus, OH 43214, USA.
Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, Yale Cancer Center, 333 Cedar Street, New Haven, CT 06510, USA.
J Geriatr Oncol. 2020 Jul;11(6):960-968. doi: 10.1016/j.jgo.2020.02.006. Epub 2020 Mar 10.
Certain cancer types and subsequent treatment can cause or worsen pain and emotional distress, leading to functional limitation, particularly among a growing population of older adults with cancer.
We constructed a national sample of older adult Medicare beneficiaries with cancer using the 2007-2012 Surveillance, Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database linked to Medicare Part D enrollment and prescription claims data. MHOS survey responses described functional limitations due to pain and emotional distress. Using multivariable logistic regression, we estimated the association between participant characteristics and patient-reported functional limitation due to pain and emotional distress and subsequent prescription medication use.
Among 9105 older adults with cancer, aged 66-102 years (y), 68.6% reported moderate to severe functional limitation due to pain, and 48.3% reported moderate to severe functional limitation due to emotional distress. Nearly 10% reported severe functional limitation due to co-occurring symptoms of pain and emotional distress. Significant predictors of severe functional limitation due to co-occurring symptoms included age ≥ 80y (ref: 66-69y, adjusted relative risk (aRR): 1.74; 95% confidence interval (CI) 1.39-2.18, p < .001), stage IV disease at diagnosis (ref: stage I, aRR: 2.08; CI 1.52-2.86, p < .001), and lung cancer (ref: breast cancer, aRR: 1.84; CI 1.30-2.61, p < .001). Among 892 participants reporting co-occurring symptoms, 32.5% received neither pain nor emotional distress prescription medication.
Functional limitation due to pain and emotional distress persist among older adults with cancer, particularly octogenarians. Efforts to identify and target unmet supportive care needs to maintain functional independence are needed.
某些癌症类型及其后续治疗会导致或加重疼痛和情绪困扰，从而导致功能受限，尤其是在癌症患者中日益增多的老年人群体中。
我们使用 2007-2012 年监测、流行病学和最终结果（SEER）-医疗保险健康结果调查（MHOS）数据库，结合医疗保险部分 D 登记和处方索赔数据，构建了一个包含癌症老年医疗保险受益人的全国性样本。MHOS 调查答复描述了因疼痛和情绪困扰而导致的功能受限。使用多变量逻辑回归，我们估计了参与者特征与患者报告的因疼痛和情绪困扰导致的功能受限以及随后使用处方药物之间的关联。
在 9105 名年龄在 66-102 岁的癌症老年患者中，68.6%报告因疼痛而出现中度至重度功能受限，48.3%报告因情绪困扰而出现中度至重度功能受限。近 10%的患者报告因疼痛和情绪困扰的共病症状而出现严重功能受限。共病症状严重功能受限的显著预测因素包括年龄≥80 岁（参考：66-69 岁，调整后的相对风险（aRR）：1.74；95%置信区间（CI）1.39-2.18，p<0.001）、诊断时 IV 期疾病（参考：I 期，aRR：2.08；CI 1.52-2.86，p<0.001）和肺癌（参考：乳腺癌，aRR：1.84；CI 1.30-2.61，p<0.001）。在 892 名报告共病症状的参与者中，32.5%既未接受疼痛也未接受情绪困扰的处方药物治疗。
癌症老年患者中疼痛和情绪困扰导致的功能受限持续存在，尤其是 80 岁以上的患者。需要努力识别和针对未满足的支持性护理需求，以保持功能独立性。
