Treatment burden is emerging as an important patient-centered outcome for older adults with cancer who concurrently manage geriatric conditions. Our objective was to evaluate the contribution of geriatric conditions to treatment burden in older adults with non-muscle invasive bladder cancer (NMIBC).
We identified 73,395 Medicare beneficiaries age 66+ diagnosed with NMIBC (Stage <II) in SEER-Medicare (2001-2014). The primary outcome was treatment burden, defined as health system contact days in the year following NMIBC diagnosis. Explanatory variables were the following geriatric conditions: multimorbidity (≥ 2 chronic conditions), functional dependency, falls, depression, cognitive impairment, weight loss, and urinary incontinence. We used negative binomial regression to model the association between individual geriatric conditions and treatment burden while adjusting for covariates.
At baseline, 64% had multimorbidity and median 3 conditions (IQR 0-5). Prevalence of other geriatric conditions ranged from 5.9%-15.2%. Adjusted mean health system contact was 8.9 days (95% CI 8.6-9.2). Multimorbidity had the largest effect size (adjusted mean 11.8 contact days (95% CI 8.3-8.8)). Each additional chronic condition conferred a 13% increased odds of health system contact (adjusted IRR 1.132, 95% CI 1.129-1.135). Regardless of number of chronic conditions, rural patients consistently had more treatment burden than urban counterparts.
In this population-based cohort of older NMIBC patients, multimorbidity and rurality were strongly associated with treatment burden in the year following NMIBC diagnosis. These findings highlight the need for interventions that reduce treatment burden due to geriatric conditions among the growing population of older adults with cancer, particularly in rural areas.
Journal of geriatric oncology. 2021 May 07 [Epub ahead of print]
Tullika Garg, Alicia Johns, Amanda J Young, Matthew E Nielsen, Hung-Jui Tan, Carmit K McMullen, H Lester Kirchner, Harvey J Cohen, Terrence E Murphy
Department of Urology, Geisinger, Danville, PA, United States of America; Department of Population Health Sciences, Geisinger, Danville, PA, United States of America. Electronic address: ., Department of Population Health Sciences, Geisinger, Danville, PA, United States of America; Biostatistics Core, Geisinger, Danville, PA, United States of America., Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America; Departments of Epidemiology and Health Policy & Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, United States of America; Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States of America., Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America., Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States of America., Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, United States of America., Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America.