Ouderen en kanker in Limburg
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1 Ouderen en kanker in Limburg Frank Buntinx, Laura Deckx, Marjan Van den Akker Gerionne Analysis of the RNH and Intego databases: prevalent and subsequent co-morbidity in cancer and non-cancer. KLIMOP: a cohort study on cancer in older cancer. 1
2 Co-morbidity Co-morbidity in cancer and non-cancer RNH: GP-based database. serious morbidity of , 69 GPs in Limburg. Included: all cancer cases diagnosed between , all skin cancers excluded. Prevalent co-morbidity: cross-sectional design. Subsequent morbidity: (retrospective) cohort design, FU=6 months to 5 years after diagnosis cancer, non-cancer, matched on age, sex and practice. If applicable, the last three months before death were excluded. 2
3 Pre-existing (Men) 40 Number of chronic diseases at time of cancer diagnosis or reference date Men 60 years Male cancer Male non-cancer Pre-existing (Women) 40 Number of chronic diseases at time of cancer diagnosis or reference date Women 60 years Female cancer Female non-cancer 3
4 Pre-existing (men) - categories Pre-existing chronic diseases (men) Cardiovascular diseases Endocrine diseases Locomotor impairment Respiratory diseases Urogenital diseases Sensory diseases Psychological disorders Skin diseases Neurological - Disability Neurological - Pain Prevalence (per 1000) Non-cancer (n=5727) Cancer (n=1997) Subsequent (men) - categories Subsequent chronic diseases (men) Cardiovascular diseases Endocrine diseases Respiratory diseases Locomotor impairment Psychological disorders Urogenital diseases Sensory diseases Neurological - Disability Skin diseases Neurological - Pain 0,0 10,0 20,0 30,0 40,0 50,0 Incidence (per 1000 person years at risk) Non-cancer (n=5727) Cancer (n=1997) 4
5 Subsequent (men) - CVD Subsequent cardiovascular diseases (men) Heart failure Stroke/cerebrovascular accident Ischemic heart disease without angina Ischemic heart disease with angina Peripheral vascular disease Acute myocardial infarction Pulmonary embolism + thrombosis Atherosclerosis Hypertension complicated Pulmonary heart disease 0,0 10,0 20,0 30,0 40,0 50,0 Incidence (per 1000 person years at risk) Non-cancer Cancer Subsequent (men) 10 most common diseases 10 most common subsequent diseases (men) Diabetes mellitus Chronic obstructive pulmonary disease Heart failure Stroke/cerebrovascular accident Ischemic heart disease without angina Ischemic heart disease with angina Peripheral vascular disease Acute myocardial infarction Dementia Benign prostatic hypertrophy 0,0 10,0 20,0 30,0 40,0 50,0 Incidence (per 1000 person years at risk) Non-cancer Cancer 5
6 Subsequent (women) - CVD Subsequent cardiovascular diseases (women) Stroke/cerebrovascular accident Heart failure Ischemic heart disease without angina Ischemic heart disease with angina Acute myocardial infarction Peripheral vascular disease Hypertension complicated Pulmonary embolism + thrombosis Atherosclerosis Pulmonary heart disease 0,0 10,0 20,0 30,0 40,0 50,0 Incidence (per 1000 person years at risk) Non-cancer Cancer KLIMOP What is the influence of a cancer diagnosis, ageing and the interaction between them on general wellbeing of older? 6
7 Influence of cancer diagnosis, ageing & their interaction on general wellbeing Wellbeing: Co-morbidity ADL, IADL, cognition, depression, Quality of life Loneliness & social network Ageing: Age (years)? Frailty? Telomere length? Immunological ageing? Design Young cancer (50-69 years) Primary diagnosis of breast, lung, prostate or gastro-intestinal cancer Older cancer ( 70 years) Primary diagnosis of breast, lung, prostate or gastro-intestinal cancer Older without any previous cancer diagnosis ( 70 jaar) Ageing Cancer 7
8 Older cancer ( 70 y) Younger cancer (50 69 y) 1 year 2 years Older noncancer ( 70 y) Baseline 6 months Carers Interview Info from medical files 2 samples of cheek mucosa (questionnaire carers) KLIMOP: inclusion Baseline 6 months 1 year Younger cancer (50 69 years) Older cancer ( 70 years) Older non-cancer ( 70 years) Totaal Aim: 2 x 375 per group 8
9 Baseline Young cancer (50 69 y) Older cancer ( 70 y) Older noncancer ( 70 y) Age(mean, SD) (5.41) (4.95) (5.44) Gender: - male 38 (28%) 30 (38%) 50 (38%) - female 99 (72%) 48 (62%) 80 (62%) Global Qol (mean, SD) (19.18) (23.39) (19.26) ADL: - Completely independent 72 (52%) 35 (47%) 37 (32%) - Reasonably independent 63 (46%) 32 (43%) 67 (57%) - Some aid necessary 1 (1%) 5 (7%) 10 (9%) - Serious need for help 0 3 (4%) 3 (3%) - Completely dependent Total Baseline Young cancer (50 69 y) Older cancer ( 70 y) Older non-cancer ( 70 y) IADL: - Independent 113 (83%) 48 (62%) 59 (45%) - Limited in 1 or more domains GDS (18%) 30 (38%) 71 (54%) - Normal 113 (82%) 54 (69%) 101 (78%) - Depressive feelings 24 (18%) 24 (31%) 29 (22%) MMSE: -Normal 128 (94%) 66 (85%) 110 (85%) -Impaired 8 (6%) 12 (15%) 19 (15%) Totaal IADL: women (score between 0 8) IADL: men (score between 0 6, extra question on reparations added) GDS-15: 0-4 = normal, 5 depressive feelings MMSE: normal (30 25), impaired( 24) 9
10 Loneliness *: loneliness scale of De Jong-Gierveld most lonely were slightly lonely (only 8 scored > 8/11) Significant positive relation with QoL in both groups of cancer Significant relation with functional status (limited in > 2 domains): significant in older cancer only: OR= 4,3 (1,3-13,7) Relation with living situation (with others alone) not significant Baseline Depression ~ Fatigue* Normal Depression ( 5) T-test N Mean (SD) N Mean (SD) P-value Younger cancer Fatigue (24.72) (31.32) 0.01 Older cancer Fatigue (25.33) (28.93) 0.00 Older non-cancer Fatigue (21.29) (29.01) 0.00 * Fatigue is measured with the EORTC QLQ-C30 subscale. A higher score means more (max = 100) 10
11 Global Quality of life: Baseline ~ 6 months Worsening (>10%) No change Improvement (>10%) Younger cancer QoL: 22 (36%) 12 (20%) 27 (44%) Older cancer QoL: 14 (52%) 6 (22%) 7 (26%) Older non-cancer QoL: 17 (23%) 30 (41%) 27 (36%) Depression: no significant differences Cognition: no significant differences n=165 Fatigue: Baseline ~ 6 months Worsening (>10%) No change Improvement (>10%) Younger cancer Fatigue 34 (56%) 18 (30%) 9 (15%) Older cancer Fatigue 10 (37%) 14 (52%) 3 (11%) Older non-cancer Fatigue 23 (31%) 28 (38%) 23 (31%) P=0.01 (worsening no worsening) n =
12 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, Research group on older cancer. Study protocol of KLIMOP: a cohort study on the wellbeing of older cancer in Belgium and the Netherlands. BMC Publ Health 2011; 11: 825 contact: laura.deckx@med.kuleuven.be - doris.van.abbema@mumc.nl 12
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