Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA.
Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
J Geriatr Oncol. 2024 Jun;15(5):101781. doi: 10.1016/j.jgo.2024.101781. Epub 2024 May 6.
Health outcome preferences of older adults with cancer vary based on burden/intensity of treatment and its impact on health outcomes such as survival, quality of life, and functional and cognitive well-being. We studied the association between age and health outcome preferences of adults with multiple myeloma (MM).
Using a single center prospective cohort study, we identified adults ≥50y with MM who underwent geriatric assessment (GA) within 30 days of initiating a new line of therapy. We assessed health outcome preferences using a nine-item health outcome preference scale where patients were asked to prioritize varying treatment outcomes in a Likert scale. We compared the response patterns for each item by age group (50-69y vs ≥70y) using Mantel-Haenszel chi-squared test. For items significant in bi-variable analysis, we built proportional odds models to study the association between age and health outcome preferences adjusting for sex, race, frailty, and high risk cytogenetics.
We included 119 patients with a median age of 65y. Of these, 58% were male, 56% were non-Hispanic White, and 28% were frail. Older adults (≥70y) versus younger adults (50-69y) were more likely to prioritize health outcomes such as quality of life (53% vs. 34%), functional independence (74% vs. 33%), maintaining cognitive ability (79% vs. 54%), and living free from pain (50% vs 18%) over longer survival (all p values <0.05). In multivariable models, each one interquartile range (IQR) increase in age was associated with increased odds of prioritization of functional independence [adjusted odds ratio (aOR) 2.55, 95% confidence interval (CI) (1.44-4.53)], maintaining cognitive ability [aOR 1.75, 95% CI (1.01-3.02)], and willingness to take milder/ fewer treatments [aOR 2.40, 95% CI (1.36-4.26)] over longer survival. Similarly, each IQR increase in age was associated with decreased odds of prioritization of survival over quality of life [aOR 0.45, 95% CI (0.26-0.78)] and survival over being free from pain [aOR 0.39, 95% CI (0.22-0.69)].
Three out of four older adults (age ≥ 70y) with MM rated other outcomes, particularly functional and cognitive well-being, above survival. Determining the most significant treatment outcomes for older adults with MM can aid in establishing treatment goals and enhance shared decision-making.
癌症老年患者的健康结果偏好因治疗负担/强度及其对生存、生活质量以及功能和认知健康等健康结果的影响而有所不同。我们研究了多发性骨髓瘤（MM）成年患者的年龄与健康结果偏好之间的关系。
使用单中心前瞻性队列研究，我们确定了在开始新的治疗线后 30 天内接受老年评估（GA）的≥50 岁 MM 成年患者。我们使用九项健康结果偏好量表评估健康结果偏好，患者在该量表中以李克特量表的形式对不同的治疗结果进行优先级排序。我们使用 Mantel-Haenszel χ2 检验比较了按年龄组（50-69 岁与≥70 岁）划分的每个项目的反应模式。对于双变量分析中显著的项目，我们构建了比例优势模型，以研究年龄与健康结果偏好之间的关联，同时调整性别、种族、脆弱性和高危细胞遗传学因素。
我们纳入了 119 名中位年龄为 65 岁的患者。其中，58%为男性，56%为非西班牙裔白人，28%为脆弱患者。与年轻患者（50-69 岁）相比，老年患者（≥70 岁）更倾向于将生活质量（53%比 34%）、功能独立性（74%比 33%）、保持认知能力（79%比 54%）和无疼痛（50%比 18%）等健康结果作为治疗目标，而非延长生存时间（所有 p 值均<0.05）。在多变量模型中，年龄每增加一个四分位间距（IQR），则与功能独立性的优先排序呈正相关[调整优势比（aOR）2.55，95%置信区间（CI）（1.44-4.53）]、保持认知能力（aOR 1.75，95%CI（1.01-3.02）]以及更愿意接受轻度/较少治疗（aOR 2.40，95%CI（1.36-4.26）]有关。同样，年龄每增加一个 IQR，与生存质量（aOR 0.45，95%CI（0.26-0.78）]和无疼痛（aOR 0.39，95%CI（0.22-0.69）]相比，生存的优先排序呈负相关。
四分之三的 MM 老年患者（年龄≥70 岁）将其他结果，尤其是功能和认知健康，视为比生存更重要的治疗目标。确定 MM 老年患者最重要的治疗目标有助于确立治疗目标，并增强共同决策。
