KLIMOP: a cohort study on the wellbeing of older cancer patients Laura Deckx Liesbeth Daniels, Katherine Nelissen, Piet Stinissen, Paul Bulens, Loes Linsen,

KLIMOP: a cohort study on the wellbeing of older cancer patients

Laura Deckx

Liesbeth Daniels, Katherine Nelissen, Piet Stinissen, Paul Bulens, Loes Linsen, Jean-Luc Rummens, Doris van Abbema, Franchette van den Berkmortel, Hans

Wildiers, Vivianne C. Tjan-Heijnen, Marjan van den Akker, Frank Buntinx

Klimop

• Klimop was conceptualised by Prof. Buntinx and Dr. Bulens after

a study performed by LIKAS in 2007 among stakeholders

• “Cancer in Limburg: Challenges and strategic options

for a coordinated approach “

• This study showed that the challenges in cancer care will be:

– The psychosocial aspects of cancer care

– Scientific research for older cancer patients

Survival: quantity or quality?

• Survival: quantity

– Survival of cancer patients increases

– Not for older cancer patients: EUROCARE project (Quaglia 2009)

• Survival: quality

– The fear to loose autonomy > the fear to die (Jolly 2006)

– Macmillan Listening Study: To study the impact of cancer on everyday life was defined as the top priority area for cancer research (Okamoto 2011)

Klimop-study

To assess the impact of cancer, ageing and their interaction on

subsequent wellbeing of older cancer patients

Inclusion (January 2011)

Baseline 6 months 1 year ...

Younger cancer patients 168 84 30

Older cancer patients 100 44 7

Older patients without cancer 157 84 25

Total interviewed 425 212 62

Lost to follow-up / 40 4

Deceased / 14 3

Comorbidity

• Comorbidity: the co-occurence of different diseases

• Comorbidity is an enormous problem (Marengoni 2011)

– Highly prevalent (55% - 98%)

– Cause of disability, functional impairment, low Qol, high health care costs

– Survival

Comorbidity

Guidelines to for the treatment of cancer patients with comorbidity are lacking! (Signaleringscommissie Kanker van KWF Kankerbestrijding 2011)

Functional status

• Maintenance of independence is very important

• Associated with survival

• Cancer patients have more functional problems (Hewitt 2003, Keating 2005)

• Little prospective studies that investigate the risk factors for

functional decline in older cancer patients

→ Cave! Selection of participants

Functional status* :Baseline ~ 6 months

Worse Idem Better

Baseline N (%) N (%) N (%)

Younger cancer patients

Impaired 16 (10%) 39 (46%) 37 (44%) 8 (10%)

Not impaired 152 (90%)

Older cancer patients

Impaired 23 (23%) 12 (27%) 21 (48%) 11 (25%)


Older patients without cancer

Impaired 45 (19%) 17 (20%) 53 (63%) 14 (17%)


*Functional status (ADL en IADL): Computed as described by Kellen et al. 2010

Baseline Functional status* ~ Loneliness

Impaired Not impaired

N N OR 95% CI


Lonely 27 (18%) 4 23 2.2 0.6 – 7.8

Not lonely 124 (82%) 9 115


Lonely 26 (35%) 10 16 4.4 1.4 – 14.0

Not lonely 48 (65%) 6 42


Lonely 56 (38%) 17 39 1.2 0.6 – 2.5

Not lonely 91 (62%) 24 67

*Functional status (ADL en IADL): Computed as described by Kellen et al. 2010

Depression

• Depression is important:

– Leading cause of disability worldwide

– Commonly coexists

– Predicts overall survival (Kanesvaran 2011 JCO)

• Depression decreased – overall survival increased!

(Giese-Davis 2011 JCO)

• Results are inconclusive

Depression:Baseline ~ 6 months

Worse(>10%)

Idem Better(>10%)

Baseline N (%) N (%) N (%)


Depressive feelings 12 (8%) 11 (15%) 44 (59%) 20 (27%)

No depressive feelings 139 (92%)







Baseline Depression ~ Loneliness

GDS-15 ≥ 5

GDS-15< 5

N N OR 95% CI


Lonely 25 (17%) 5 20 4.8 1.3 – 17.1

Not lonely 120 (83%) 6 114


Lonely 25 (35%) 7 18 8.6 1.6 – 45.2

Not lonely 46 (65%) 2 44


Lonely 55 (38%) 14 41 9.9 2.7 – 36.4

Not lonely 90 (62%) 3 87

Quality of life

• What is the impact of cancer, cancer treatment, ageing and

their interaction on Qol?

– Results are inconclusive

• Methodological shortcomings (Joly 2007)

– Cross-sectional

– Presentation of mean values!

– Prospective but Qol measured only once

– Selection of patients

Global Qol:Baseline ~ 6 months

Worse(>10%)

Idem Better(>10%)

N (%) N (%) N (%)


Global Qol 31 (38%) 15 (19%) 35 (43%)


Global Qol 18 (55%) 8 (24%) 7 (21%)


Global Qol 17 (21%) 35(43%) 30 (37%)

Wellbeing

Little is known about the

interaction between the

co-occurrence of

-Comorbidity

-Functional impairment

-Geriatric syndromes

(Koroukian 2011 JCO)

Preliminary conclusions

• Results are preliminary and cross-sectional! The longer the duration

of the study, the more valuable the results will be

• Loneliness and depression are frequent and important factors that

can be influenced

• Guidelines for care of cancer patients with multimorbidity are

needed, taking into account:

– Co-morbidity/functional impairment/…

– Consequences of cancer treatment

– Collaboration between different disciplines in primary and secondary care

Take home message

• Be critical!– Was the study population appropriate?– Cross-sectional design versus prospective design?

• Older cancer patients

– Heterogeneous group

– Specific health care needs

• Quality rather than quantity of survival

– Which factors determine maintenance or decline of wellbeing?

“Knowing is not enough; we must apply. Willing is not enough; we must do.” Goethe

[email protected]@[email protected]

www.ouderenenkanker.be

Deckx L, Van Abbema D, Nelissen K, Daniels L, Stinissen P, Bulens P, Linsen L, Rummens JL, Van den Berkmortel F, Robaeys G, De Jonge E, Houben B, Pat K, Walgraeve D, Spaas L, Verheezen J, Verniest T, Goegebuer A, Wildiers H, Tjan-Heijnen V, Buntinx F, Van den Akker M. Study

protocol of KLIMOP: a cohort study on the wellbeing of older cancer patients in Belgium and the Netherlands. BMC Publ Health 2011; 11: 825

Contact:

KLIMOP is funded by VLK, the Flemisch League against Cancer and Interreg IVcross-border region Flanders – the Netherlands

Documents

KLIMOP: a cohort study on the wellbeing of older cancer patients Laura Deckx Liesbeth Daniels, Katherine Nelissen, Piet Stinissen, Paul Bulens, Loes Linsen,