School of Public Health, San Diego State University, San Diego, CA, USA; Center for Health Equity, Education, and Research, School of Medicine, UC San Diego, La Jolla, CA, USA; Division of Radiation Medicine and Applied Sciences, School of Medicine, UC San Diego, La Jolla, CA, USA; Division of Geriatrics, Gerontology, and Palliative Medicine, UC San Diego, CA, USA.
Department of Surgery, School of Medicine, UNC Chapel Hill, Chapel Hill, NC, USA.
J Geriatr Oncol. 2023 Nov;14(8):101610. doi: 10.1016/j.jgo.2023.101610. Epub 2023 Sep 2.
Older adults living with Alzheimer's disease and related dementias (ADRD) who are then diagnosed with cancer are an understudied population. While the role of cognitive impairment during and after cancer treatment have been well-studied, less is understood about patients who are living with ADRD and then develop cancer. The purpose of this study is to contribute evidence about our understanding of this vulnerable population.
This was a retrospective cohort study of a linked, representative family of databases of cancer registries and Medicare administrative claims that make up the SEER-Medicare database. Older adults ages 68 and older with a first primary cancer type: breast, cervical, colorectal, lung, oral, or prostate were eligible for inclusion (N = 337,932). Prevalence estimates of ADRD across cancer types and a 5% non-cancer comparison sample were compared by patient factors.
The overall prevalence of patients who had an ADRD diagnosis anytime in the three years prior to their cancer diagnosis was 5.6%. Patients with ADRD were more likely to be female, older (over age 75), a racial/ethnic minority, single, with multiple chronic conditions, and a tumor diagnosed early (stage I) or were unstaged. Black patients with colorectal and oral cancer had the highest and second highest prevalence of ADRD compared to White patients (13.46% vs 7.95% and 12.64% vs 7.82% respectively, p < .0001). We observed the highest prevalence of ADRD among Black patients for breast (11.85%), cervical (11.98%), lung (8.41%), prostate (4.83), and the 5% sample (9.50%, p > .0001).
The higher prevalence of ADRD among Black and Latine older adults with cancer not only aligns with the trend observed in our non-cancer comparison sample, but also, these findings demonstrate the compounded risk experienced by minoritized older adults over the life course. The greater than expected prevalence of patients with ADRD who go on to develop cancer demonstrates better assessment of cognition is urgently needed. Accurate identification of these vulnerable populations is critical to improve assessment, care coordination, and address inequities in screening and treatment planning.
患有阿尔茨海默病和相关痴呆症（ADRD）的老年患者在被诊断出患有癌症后，成为了一个研究不足的群体。虽然在癌症治疗期间和之后认知障碍的作用已经得到了充分研究，但对于同时患有 ADRD 并随后发展为癌症的患者，人们的了解则较少。本研究的目的是为我们对这一脆弱群体的理解提供证据。
这是一项回顾性队列研究，涉及癌症登记处和医疗保险管理索赔的代表数据库的关联家庭，这些数据库构成了 SEER-医疗保险数据库。年龄在 68 岁及以上、首次患有乳腺癌、宫颈癌、结直肠癌、肺癌、口腔癌或前列腺癌的患者符合纳入标准（N=337932）。通过患者因素比较了不同癌症类型和 5%非癌症对照样本中 ADRD 的患病率估计值。
在癌症诊断前三年内任何时候被诊断出患有 ADRD 的患者总体患病率为 5.6%。患有 ADRD 的患者更可能是女性、年龄较大（75 岁以上）、少数民族、单身、患有多种慢性疾病且肿瘤诊断较早（I 期）或未分期。与白人患者相比，黑人群体中患有结直肠癌和口腔癌的患者 ADRD 的患病率最高和第二高（分别为 13.46%比 7.95%和 12.64%比 7.82%，p<.0001）。我们观察到黑人群体中乳腺癌（11.85%）、宫颈癌（11.98%）、肺癌（8.41%）、前列腺癌（4.83%）和 5%对照样本（9.50%）的 ADRD 患病率最高，p>.0001）。
患有癌症的黑人和拉丁裔老年成年人中 ADRD 的更高患病率不仅与我们非癌症对照样本中观察到的趋势一致，而且这些发现还表明少数族裔老年成年人在整个生命过程中面临的风险更大。患有 ADRD 并随后发展为癌症的患者的患病率高于预期，这表明迫切需要更好地评估认知能力。准确识别这些弱势群体对于改善评估、护理协调以及解决筛查和治疗计划中的不平等问题至关重要。
