Galvin Angéline, Amadéo Brice, Frasca Matthieu, Soubeyran Pierre, Rondeau Virginie, Delva Fleur, Pérès Karine, Coureau Gaëlle, Helmer Catherine, Mathoulin-Pélissier Simone
Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France.
Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France.
J Geriatr Oncol. 2023 Jul;14(6):101539. doi: 10.1016/j.jgo.2023.101539. Epub 2023 Jun 13.
Several population-based studies have reported disparities in overall survival (OS) among older patients with cancer. However, geriatric syndromes, known to be associated with OS in the geriatric population, were rarely studied. Thus, our aim was to identify the determinants of OS among French older adults with cancer, including geriatric syndromes before cancer diagnosis.
Using cancer registries, we identified older subjects (≥65 years) with cancer in three French prospective cohort studies on aging from the Gironde department. Survival time was calculated from the date of diagnosis to the date of all-cause death or to the date of last follow-up, whichever came first. Demographic and socioeconomic characteristics, smoking status, self-rated health, cancer-related factors (stage at diagnosis, treatment), as well as geriatric syndromes (polypharmacy, activity limitation, depressive symptomatology, and cognitive impairment or dementia) were studied. Analyses were performed using Cox proportional hazard models for the whole population, then by age group (65-84 and 85+).
Among the 607 subjects included in the study, the median age at cancer diagnosis was 84 years. Smoking habits, activity limitations, cognitive impairment or dementia, advanced cancer stage and absence of treatment were significantly associated with lower OS in the analysis including the whole population. Women presented higher OS. Factors associated with OS differed by age group. Polypharmacy was inversely associated with OS in older adults aged 65-84 and 85 + .
Our findings support that geriatric assessment is needed to identify patients at higher risk of death and that an evaluation of activity limitation in older adults is essential. Improving early detection could enable interventions to address factors (activity limitations, cognitive impairment) associated with OS, potentially reducing disparities and lead to earlier palliative care.
多项基于人群的研究报告了老年癌症患者总体生存率（OS）的差异。然而，老年综合征虽在老年人群中与总体生存率相关，但却很少被研究。因此，我们的目的是确定法国老年癌症患者总体生存率的决定因素，包括癌症诊断前的老年综合征。
利用癌症登记处的数据，我们在法国吉伦特省三项关于衰老的前瞻性队列研究中确定了年龄≥65岁的癌症患者。生存时间从诊断日期计算至全因死亡日期或最后随访日期，以先到者为准。研究了人口统计学和社会经济特征、吸烟状况、自评健康状况、癌症相关因素（诊断时的分期、治疗情况）以及老年综合征（多重用药、活动受限、抑郁症状以及认知障碍或痴呆）。对整个人群使用Cox比例风险模型进行分析，然后按年龄组（65 - 84岁和85岁及以上）进行分析。
在纳入研究的607名受试者中，癌症诊断时的中位年龄为84岁。在包括整个人群的分析中，吸烟习惯、活动受限、认知障碍或痴呆、癌症晚期以及未接受治疗与较低的总体生存率显著相关。女性的总体生存率较高。与总体生存率相关的因素因年龄组而异。在65 - 84岁和85岁及以上的老年人中，多重用药与总体生存率呈负相关。
我们的研究结果支持需要进行老年评估以识别死亡风险较高的患者，并且对老年人活动受限的评估至关重要。改善早期检测可以使针对与总体生存率相关的因素（活动受限、认知障碍）的干预措施得以实施，有可能减少差异并促使更早地提供姑息治疗。
