Division of Hematology/Oncology, Department of Medicine, University of California, Davis, Sacramento, CA, USA.
Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
J Geriatr Oncol. 2024 Nov;15(8):102068. doi: 10.1016/j.jgo.2024.102068. Epub 2024 Sep 16.
Among older adults without cancer, living alone is associated with poor health outcomes. However, among older adults with non-small cell lung cancer (NSCLC) who live alone, data on function, cognition, and quality of life (QOL) during systemic treatment remain limited.
We enrolled adults aged ≥65 with advanced NSCLC starting a new chemotherapy, immunotherapy, and/or targeted therapy regimen with non-curative intent. Patients completed geriatric assessments including instrumental activities of daily living (IADL), Montreal Cognitive Assessment, and QOL pretreatment and at 1, 2, 4, and 6 months, or until treatment discontinuation, whichever occurred earlier. We categorized change in IADL, cognition, and QOL as stable/improved, declined with recovery, or declined without recovery using clinically meaningful definitions of change. We used multinomial logistic regression to compare change between patients who lived alone versus with others.
Among 149 patients, median age was 73; 21% lived alone. Pretreatment IADL, cognition, and QOL scores were similar between older adults who lived alone versus with others. During NSCLC treatment, older adults who lived alone had similar trajectories of function (52% functional decline vs 38%), cognition (43% cognitive decline vs 50%), and QOL (45% QOL decline vs 44%) compared with those who lived with others. In unadjusted analyses, patients who lived alone were more likely to develop functional decline with recovery (reference category: stable/improved function) than those who lived with others (relative risk ratio 4.07, 95% CI 1.14-14.6, p = 0.03). However, this association was not observed after adjusting for age, race, prior NSCLC treatment, current treatment group, and pretreatment geriatric assessment differences. There were no differences in cognitive or QOL trajectories in unadjusted or adjusted analyses.
Approximately half of older adults with advanced NSCLC who lived alone were able to maintain their function, cognition, and QOL during NSCLC treatment, which was similar to older adults who lived with others. Many older adults with advanced NSCLC who live alone can receive systemic treatment with individualized supportive care.
在没有癌症的老年人中，独居与健康状况不佳有关。然而，在独居的非小细胞肺癌 (NSCLC) 老年患者中，关于系统治疗期间的功能、认知和生活质量 (QOL) 的数据仍然有限。
我们招募了年龄≥65 岁、患有晚期 NSCLC 的成年人，他们正在开始新的化疗、免疫治疗和/或靶向治疗方案，这些方案没有治愈意图。患者在治疗前和治疗后 1、2、4 和 6 个月或直至治疗停止前，完成了包括日常生活活动能力 (IADL)、蒙特利尔认知评估和 QOL 在内的老年评估。我们使用临床有意义的变化定义，将 IADL、认知和 QOL 的变化归类为稳定/改善、恢复性下降或无恢复性下降。我们使用多项逻辑回归比较独居与非独居患者之间的变化。
在 149 名患者中，中位年龄为 73 岁；21%独居。治疗前，独居和非独居老年人的 IADL、认知和 QOL 评分相似。在 NSCLC 治疗期间，与与他人同住的老年人相比，独居的老年人的功能（52%功能下降）、认知（43%认知下降）和 QOL（45% QOL 下降）轨迹相似。在未调整的分析中，与与他人同住的患者相比，独居的患者更有可能出现恢复性功能下降（参考类别：功能稳定/改善）（相对风险比 4.07，95%置信区间 1.14-14.6，p=0.03）。然而，在调整年龄、种族、既往 NSCLC 治疗、当前治疗组和治疗前老年评估差异后，这种关联并不明显。在未调整或调整后的分析中，认知或 QOL 轨迹没有差异。
大约一半独居的晚期 NSCLC 老年患者在 NSCLC 治疗期间能够维持其功能、认知和 QOL，这与与他人同住的老年患者相似。许多独居的晚期 NSCLC 老年患者可以接受个体化支持性治疗的系统治疗。
