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Jeon M, Jang H, Jeon H, Park CG, Kim S. Long-term late effects in older gastric cancer survivors: Survival analysis using Cox hazard regression model by retrospective electronic health records. Support Care Cancer 2023; 32:29. [PMID: 38099981 PMCID: PMC10724335 DOI: 10.1007/s00520-023-08202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE Because the population of older gastric cancer survivors (GCSs) is growing, understanding the long-term late effects experienced by these GCSs and their impact on survival outcomes is crucial for optimizing survivorship care. This study aims to identify and characterize these effects and investigate their association with survival outcomes. METHODS A retrospective analysis of electronic health records was conducted on 9,539 GCSs diagnosed between 2011 and 2017. The GCSs were divided into two age groups (< 65 and ≥ 65 years) and the long-term late effects were categorized by age using Cox proportional hazard models. The impact of clinical factors and age-specific late effects on survival was evaluated in the older GCSs. RESULTS Among the total GCSs, 37.6% were over and 62.4% were under 65 years of age. Significant differences between the age groups were observed in the cumulative hazard ratios (HRs) for iron and vitamin B12 levels and prognostic nutritional index (PNI) scores. In older GCSs, abnormal iron levels (HR 1.98, 95% CI 1.16-3.41, p = .013) and poor PNI scores (HR 1.59, 95% CI 1.03-2.47, p = .038) were associated with poorer survival outcomes. Additionally, being female was identified as a risk factor for lower survival rates (if male, HR 0.42, 95% CI 0.18-0.98, p = .045). CONCLUSION This study highlights the typical long-term late effects experienced by older GCSs. By tailoring survivorship care to address nutritional-, age-, and gender-related factors, the overall survival and quality of life of older GCSs can be improved.
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Affiliation(s)
- Misun Jeon
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Hyoeun Jang
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Heejung Jeon
- Department of Nursing, Graduate School, Yonsei University, Seoul, South Korea
| | - Chang Gi Park
- College of Nursing, University of Illinois, Chicago, IL, USA
| | - Sanghee Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea.
- Department of Artificial Intelligence, College of Computing, Yonsei University, Seoul, South Korea.
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Liu L, Zhang A, Su M, Sun X, Shao D, Cheng J, Yao N(A. The development and validation of a patient-reported outcome measure to assess financial hardship among older cancer survivors in China: hardship and recovery with distress survey. Front Oncol 2023; 13:1151465. [PMID: 37152015 PMCID: PMC10162643 DOI: 10.3389/fonc.2023.1151465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/28/2023] [Indexed: 05/09/2023] Open
Abstract
Background Financial hardship has been described as a patient's economic experiencefollowing cancer-related treatment. Standardized patient-reported outcome measures(PROM) to assess this distress has not been well-studied, especially among older cancer survivors. Objective The aim of this study was to develop and validate PROM for assessing the financial hardship of older cancer survivors in China. Methods Items were generated using qualitative interviews and literature review. Items were screened based on Delphi expert consultation and patients' opinions. Item response theory (IRT) and classical test theory (CTT) were used to help reduce items. Retained items formed a pilot instrument that was subjected to psychometric testing. A cut-off score for the new instrument for predicting poor quality of life was identified by receiver operating characteristic (ROC) analysis. Results Qualitative interviews and literature review generated 135 items, which were reduced to 60 items because of redundancy. Following Delphi expert consultation and patients' evaluation, 24 items with high importance were extracted. Sixteen items were selected due to satisfactory statistical analysis based on CTT and IRT. Ten items were retained and comprised 2 domains after loadings in exploratory factor analysis (EFA). Internal consistency was satisfactory (α = 0.838). Test-retest reliability was good (intraclass correlation, 0.909). The ROC analysis suggested that the cut-off of 18.5 yielded an acceptable sensitivity and specificity. Conclusions The PROM for Hardship and Recovery with Distress Survey (HARDS) consists of 10 items that specifically reflect the experiences of financial hardship among older Chinese cancer survivors, and it also showed good reliability and validity in clinical settings.
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Affiliation(s)
- Li Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Aihua Zhang
- School of Nursing, Shandong First Medical University, Shandong Academy of Medical Sciences, Taian, Shandong, China
| | - Mingzhu Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
- *Correspondence: Mingzhu Su,
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Di Shao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Joyce Cheng
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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