Three Years Survival of Elderly Cancer Patients in Indonesia: Do We Need a Different Approach?

Noorwati Sutandyo, Sri Agustini Kurniawati, Nia Novianti Siregar, Nina Kemala Sari

Abstract


Background: the number of elderly people in Indonesia is increasing. Additionally, cancer prevalence among older patients is also increasing. However, studies assessing clinical factors associated with the survival of elderly patients with cancer are still lacking. This study aimed to investigate the survival of geriatric patients with cancer and associated factors. Methods: this was a retrospective cohort study. Subjects were geriatric patients with cancer aged >60 years, enrolled between 2013 and 2015 in Dharmais Cancer Hospital. Data were retrieved from medical records and consisted of gender, age, cancer type, stage, Eastern Cooperative Oncology Group (ECOG) performance status (PS), body mass index (BMI), Charlson Comorbidity Index, and type of treatment. Cox regression analysis was used to identify independent prognostic factors for survival. Results: a total of 249 patients were enrolled, with a median age of 66 (60–85) years. The most common cancer was of the lung, followed by breast, colorectal, and uterine cervical cancers. The median survival time was 24 months. Cox multivariate analysis was performed by gender stratification. Advanced stage cancer (III-IV) was identified as the risk factor for mortality in female patients (hazard ratio [HR] 2.72; 95% confidence interval [CI] 1.53–4.80; p = 0.001), while poor performance status (ECOG 2 – 4) was the risk factor in male group (HR 1.82; 95% CI 1.01–3.24; p = 0.04). Conclusion: the survival of elderly patients with cancer is affected by traditional prognostic factors. Advanced cancer stage was significant independent prognostic factor in female patients, while poor performance status was significant in male patients.


Keywords


Elderly patients;geriatric assessment; survival

References


Statistics Indonesia (Badan Pusat Statistik). Statistics of aging population 2017. Jakarta: Badan Pusat Statistik, 2018.

Arnold M, Karim-Kos HE, Coebergh JW, et al. Recent trends in incidence of five common cancers in 26 European countries since 1988: analysis of the European Cancer Observatory. Eur J Cancer. 2015;51:1164–87.

Terret C. Management and geriatric assessment of cancer in the elderly. Expert Rev Anticancer Ther. 2004:4(3):469–75.

Caillet P, Laurent M, Bastuji-Garin S, et al. Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment. Clin Interv Aging. 2014;9:1645–60.

Bastiaannet E, Liefers GJ, de Craen AJM, et al. Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Breast Cancer Res Treat. 2010;124(3):801–7.

Berger NA, Savvides P, Koroukian SM, et al. Cancer in the elderly. Trans Am Clin Climatol Assoc. 2006;117:147 – 55.

Bourdel-Marchasson, Diallo A, Bellera C, et al. One-year mortality in older patients with cancer: development and external validation of an MNA-based prognostic score. PLoS One. 2016;11(2):e0148523.

Ministry of Health. Riset Kesehatan Dasar (Basic Health Research). National Institute for Health Research and Development, Ministry of Health, Republic of Indonesia: Jakarta, 2018. Downloaded from: http://www.depkes.go.id/resources/download/info-terkini/materi_rakorpop_2018/Hasil%20Riskesdas%202018.pdf. Last access: 20 January 2019.

Soto-Perez-de-Celis E, de Glas NA, Hsu T, et al. Global geriatric oncology: Achievements and challenges. J Geriatr Oncol. 2017;8(5):374–86.

World Health Organization (WHO). The Uses of Epidemiology in the Study of the Elderly: Report of a WHO Scientific Group on the Epidemiology of Aging. Technical Report Series. Geneva, Switzerland: WHO; 1984.

World Health Organization, Western Pacific Region. The Asia-Pacific perspective: redefining obesity and its treatment. International Association for the Study of Obesity; 2000.

Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

Oken MM, Creech RH, Torney DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J ClinOncol. 1982:5:649–55.

Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.

Cox DR. Regression models and life-tables. J Royal Stat Soci Series B, Stat Methodol. 1972;34:187–220.

Loh KP, Soto-Perez-de-Celis E, Hsu T, et al. What every oncologist should know about geriatric assessment for older patients with cancer: young international society of geriatric oncology position paper. J Oncol Pract. 2018;14(2):85 – 94.

Galvin, Delva F, Helmer C, et al. Sociodemographic, socioeconomic, and clinical determinants of survival in patients with cancer: a systematic review of the literature focused on the elderly. J Geriatr Oncol. 2018;9(1):6–14.

Jung KW, Park S, Shin A, et al. Do female cancer patients display better survival rate compared with males? Analysis of the Korean National Registry Data, 2005 – 2009. PLoS ONE. 2012;7(13): e52457.

Cook MB, McGlynn KA, Devesa SS, Freedman ND, Anderson WF. Sex disparities in cancer mortality and survival. Cancer Epidemiol Biomarkers Prev. 2011; 20(8):1629 – 37.

Extermann M, Hurria A. Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol. 2007;25:1824–31.

Reuben DB, Rubenstein LV, Hirsch SH, et al. Value of functional status as a predictor of mortality: Results of a prospective study. Am J Med. 1992; 93:663-9.

Sargent DJ, Köhne CH, Sanoff HK, et al. Pooled safety and efficacy analysis examining the effect of performance status on outcomes in nine first-line treatment trials using individual data from patients with metastatic colorectal cancer. J Clin Oncol. 2009;27(12):1948–55.

Hawkes N. Cancer survival data emphasize importance of early diagnosis. BMJ. 2019;364:I408.

Saadatmand S, Bretveld R, Siesling S, Tilanus-Linthorst M. Influence of tumour stage at breast cancer detection on survival in modern times: population based study in 173797 patients. BMJ. 2015;351:h4901.

Vandewoude M. Nutritional assessment in geriatric cancer patients. Support Care Cancer. 2010;18(suppl 2):S51–S56.

Blanc-Bisson C, Fonck M, Rainfray M, Soubeyran P, Bourdel-Marchasson I. Undernutrition in elderly patients with cancer: target for diagnosis and intervention. Crit Rev Oncol Hematol. 2008;67(3):243–54.

Newman AB, Yanez D, Harris T, Duxbury A, Enright PL, Fried LP, for the Cardiovascular Study Research Group. Weight change in old age and its association with mortality. J Am Geriatr Soc. 2001;49:1309–18.

Barao K, Cavagnari MAV, Fucuta PS, Forones NM. Association between nutrition status and survival in elderly patients with colorectal cancer. Nutr Clin Pract. 2017;32(5):658–63.

Stenholm S, Mehta NK, Elo IT, Heliovaara M, Koskinen S, Aromaa A. Obesity and muscle strength as long-term determinants of all-cause mortality – a 33 year follow-up of the Mini Finland Health Examination. Int J Obes (Lond). 2014;38:1126–32.

Caan BJ, Meyerhardt JA, Kroenke CH, et al. Explaining the obesity paradox: The association between body composition and colorectal cancer survival (C-SCANS Study). Cancer Epidemiol Biomarkers Prev. 2017;26(7):1008–15.

Marosi C, Köller M. Challenge of cancer in the elderly. ESMO Open. 2016;1:3000020.

Lichtman SM, Wildiers H, Chatelut E, et al. International Society of Geriatric Oncology Chemotherapy Taskforce: evaluation of chemotherapy in older patients – an analysis of the medical literature. J Clin Oncol. 2007;25:1832–43.

Thiels CA, Bergquist JR, Meyers AJ, et al. Outcomes with multimodal therapy for elderly patients with rectal cancer. Br J Surg. 2016;103(2):e106-14.

Coate LE, Massey C, Hope A, et al. Treatment of the elderly when cure is the goal: influence of age on treatment selection and efficacy for stage III non-small cell lung cancer. J Thorac Oncol. 2011;6:537-44.


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