Predicting 5- and 10-year survival in older women with early-stage breast cancer: self-rated health and walking ability

Associations Between Self-Rated Health and Mortality in the Norwegian Women and Cancer (NOWAC) Study

Purpose

We investigated the association between self-rated health (SRH) and cancer incidence and SRH and all-cause mortality among Norwegian women.

Population and Methods

We used data from 110,104 women in the Norwegian Women and Cancer (NOWAC) cohort aged 41-70 years at baseline. We used flexible parametric survival analysis with restricted cubic splines to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between SRH and mortality in the entire cohort. We employed the same method in a multistate design to assess associations between baseline SRH and 1) cancer incidence, and 2) all-cause mortality in subgroups of women who did and did not receive a cancer diagnosis during follow-up.

Results

With very good SRH as reference category for all associations and median age at end of follow-up, lower SRH was associated with increased mortality (HRgood SRH 1.19, 95% CI 1.12-1.26) and HRpoor SRH 1.81, 95% CI 1.66-1.97). Lower SRH at baseline was associated with cancer incidence (HRgood SRH 1.14, 95% CI 1.08-1.20 and HRpoor SRH 1.44, 95% CI: 1.32-1.58). Poor baseline SRH was associated with increased mortality for women who received a cancer diagnosis (HRpoor SRH 1.20, 95% CI 1.04-1.39), and SRH showed a strong association with increased mortality for women who stayed cancer free (HRgood SRH 1.59, 95% CI 1.44-1.77 and HRpoor SRH 3.34, 95% CI 2.91-3.84).

Conclusion

Lower SRH at baseline predicted increased cancer risk and all-cause mortality in middle-aged to older women. Poor SRH at baseline predicted all-cause mortality in women who later received a cancer diagnosis. Both good and poor SRH at baseline predicted all-cause mortality in women who stayed cancer-free, and the association was stronger for these women compared to both the entire cohort and to women who were subsequently diagnosed with cancer.

Postdiagnosis recreational physical activity and breast cancer prognosis: Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis

It is important to clarify the associations between modifiable lifestyle factors such as physical activity and breast cancer prognosis to enable the development of evidence-based survivorship recommendations. We performed a systematic review and meta-analyses to summarise the evidence on the relationship between postbreast cancer diagnosis physical activity and mortality, recurrence and second primary cancers. We searched PubMed and Embase through 31st October 2021 and included 20 observational studies and three follow-up observational analyses of patients enrolled in clinical trials. In linear dose-response meta-analysis of the observational studies, each 10-unit increase in metabolic equivalent of task (MET)-h/week higher recreational physical activity was associated with 15% and 14% lower risk of all-cause (95% confidence interval [CI]: 8%-22%, studies = 12, deaths = 3670) and breast cancer-specific mortality (95% CI: 4%-23%, studies = 11, deaths = 1632), respectively. Recreational physical activity was not associated with breast cancer recurrence (HR = 0.97, 95% CI: 0.91-1.05, studies = 6, deaths = 1705). Nonlinear dose-response meta-analyses indicated 48% lower all-cause and 38% lower breast cancer-specific mortality with increasing recreational physical activity up to 20 MET-h/week, but little further reduction in risk at higher levels. Predefined subgroup analyses across strata of body mass index, hormone receptors, adjustment for confounders, number of deaths, menopause and physical activity intensities were consistent in direction and magnitude to the main analyses. Considering the methodological limitations of the included studies, the independent Expert Panel concluded 'limited-suggestive' likelihood of causality for an association between recreational physical activity and lower risk of all-cause and breast cancer-specific mortality.

Education Moderates the Association between Depressive Symptoms and Self-Rated Health among Older Adults with Cancer

This study examined the association between depressive symptoms and self-rated health (SRH) and whether and how such association varies by education among older adults with cancer. Data came from the 2019 National Health Interview Survey. A total of 2,470 participants aged 65 or older who had been diagnosed with cancer by a doctor or other health professional were included in this study. Ordinal logistic regression was used to examine the association between depressive symptoms and SRH and whether and how such association varies by education among older adults with cancer. More depressive symptoms were associated with worse SRH. Such association became stronger with higher education among older adults with cancer. Findings confirm the associations between depressive symptoms and SRH among older adults with cancer. The differential impact of education on SRH and on the association between depressive symptoms and SRH highlights the importance of considering patients' educational attainment in a more comprehensive way when working with older adults with cancer. When conducting distress screening among cancer survivors, oncology social workers should be aware of the complex relationship between education and depression in relation to cancer survivors' SRH.

How do I deal with breast cancer: a qualitative inquiry into the coping strategies of Iranian women survivors

Background

Breast cancer is the most frequent cancer in Iran. Understanding the coping strategies employed by cancer survivors can provide valuable information for designing interventions to help them adapt to the problems produced by cancer and its treatment. This study aimed to explore the coping strategies of BC survivors in Iran.

Methods

This qualitative study was conducted in Mashhad, Northeast Iran, between April and December 2021. Fourteen BC survivors were selected through purposive sampling. The data were collected using semi-structured interviews. Data were analyzed using conventional content analysis adopted by Graneheim and Lundman. MAXQDA 12 software was used for data organization. Components of trustworthiness, including credibility, dependability, confirmability, and transferability, were considered.

Results

The main categories that emerged from the participants' data analysis were “behavioral coping strategies” and “emotional coping strategies.” Behavioral coping strategies included efforts to adopt healthy nutrition, attempts to improve a healthy lifestyle, maintenance of everyday activities, use of specialized cancer support consultation services, and seeking to increase health literacy about BC. The emotional coping strategies consisted of denial as a temporary escape route, positive thinking and focusing on the positive aspects of life, reinforcement of spirituality, and seeking the support of relatives.

Conclusion

Our findings provide an in-depth understanding of Iranian women’s strategies for coping with BC. A trained team of oncologists, psychiatrists, mental health professionals, and reproductive health specialists needs to contribute significantly to improving the coping ability of patients with cancer, which could lead to enhanced health promotion and a higher quality of life.

Age as a moderator for the association between depression and self-rated health among cancer survivors: a U.S. based population study

BACKGROUND

Self-rated health (SRH) is a salient outcome for cancer survivors. Although depression is a well-studied correlate with SRH, few studies have focused on the role of cancer survivors' age on the association between depression and SRH. This study evaluates demographic and psychosocial factors associated with cancer survivors' SRH. We also assess the moderating role of age to the association between depression and SRH.

MATERIALS AND METHODS

This paper analyzed 2,470 U.S. cancer survivors from the 2019 National Health Interview Survey. Two ordered logistic regression models with complex survey weights were used for analyses. Missing data was addressed using multiple imputations by chained equations.

RESULTS

Being female, higher education and higher income were positively associated with better SRH. While the relationship between higher education and higher income was consistent with previous findings, the positive association between being female and SRH was different from previous studies. Age significantly moderated the association between depression and SRH, evidenced by results of the joint tests of all interaction term coefficients being statistically significant, F(2, 544.6) = 5.13, p < 0.01.

CONCLUSIONS

The findings of the study highlighted the significance of screening for social determinants of health and health disparity when supporting cancer survivors. Additionally, findings of this study emphasized the significance of adopting an age-specific approach when evaluating and addressing depression across different age groups of cancer survivors.

Assessing the Expression of Emotions in Breast Cancer Survivors during the Time of Recovery: Perspective from Focus Groups

Breast cancer has major public health implications, as it is the most frequent malignant tumor and the leading cause of cancer death in women. Survivors have many needs, including strategies to cope with the associated distress. We explore whether focus groups are useful for nurses to obtain information about the emotional state of breast cancer women, and develop strategies for coping with the stress that this disease entails. A qualitative study was carried out, involving 25 focus groups with 83 women treated for breast cancer, recruited from the local Breast Cancer Association (ALMOM). Four open-ended questions were employed, and 60-min discussions were carried out. They were transcribed, analyzed, coded, and the themes identified. Four major themes emerged, including "complex emotional evolution", "emotional isolation", "lack of information" and "inability to give advice". Women admitted that this disease had been a stressful factor for them, causing emotional (anxiety, irritability, anger or guilt) and cognitive disorders (confusion, lack of concentration, forgetfulness). The use of focus groups in breast cancer survivors allows nurses to evaluate the expression of emotions in these women, and collect and share information about their feelings, thoughts and experiences, so that survivors can cope more easily with the stress related to their illness.

Use of Single-Item Self-Rated Health Measure to Identify Frailty and Geriatric Assessment-Identified Impairments Among Older Adults with Cancer

Background

Poor self-rated health (SRH) is a known predictor of frailty and mortality in the general population; however, its role among older adults with cancer is unknown. We evaluated the role of SRH as a potential screening tool to identify frailty and geriatric assessment (GA)-identified impairments.

Materials and Methods

Adults ≥60 years diagnosed with cancer in the UAB Cancer & Aging Resilience Evaluation (CARE) registry underwent a GA at the time of initial consultation. We measured SRH using a single-item from the Patient-Reported Outcomes Measurement Information System global health scale and dichotomized responses as poor (poor, fair) and good (good, very good, and excellent). We evaluated the diagnostic performance of SRH in measuring frailty, and GA impairment (≥2 deficits among a set of seven GA domains). We examined the impact of SRH with survival using a Cox model adjusting for confounders, exploring the mediating role of frailty.

Results

Six hundred and three older adults with cancer were included, with a median age of 69 years. Overall, 45% (n = 274) reported poor SRH. Poor SRH demonstrated high sensitivity and specificity for identifying frailty (85% and 78%, respectively) and GA impairment (75% and 78%, respectively). In a Cox regression model, poor SRH was associated with inferior survival (HR = 2.26; 95% CI 1.60-3.18) after adjusting for confounders; frailty mediated 69% of this observed relationship.

Conclusion

Self-rated health may be used as a screening tool to identify older adults with cancer with frailty and GA impairments. Poor SRH is associated with inferior survival, which is mediated by frailty.

Evaluating the association of self-reported psychological distress and self-rated health on survival times among women with breast cancer in the U.S

BACKGROUND

Psychological distress and self-rated health status may create additional complexities in patients already diagnosed with breast cancer. This study aims to assess the association of self-report-based assessment of psychological distress and self-rated health on survival times among women with breast cancer diagnoses.

METHODS

Seventeen-year data from the Integrated Public Use Microdata Series-National Health Interview Survey (IPUMS-NHIS) were pooled and analyzed. Women who were aged 30 to 64 years old, with breast cancer diagnosis were selected (n = 2,819). The outcome variable was time to death. The independent variables were self-reported assessment of psychological distress and self-rated health. Psychological distress was defined using the Kessler-6 scale while self-rated health was measured on a 3-point Likert scale: Poor, Fair, and Good-to-Excellent (referred to as good for brevity). We computed unadjusted and adjusted hazard ratios (HR) using Cox-Proportional Hazard regression models with sociodemographic characteristics and measures of health care access used as potential confounders. Significance was set at alpha = 0.05.

RESULTS

Women with breast cancer assessed as having psychological distress had 46% (Adjusted HR: 1.46; 95% CI: 1.02-2.09) increased risks of mortality. Also, women who rated their health as poor or fair had a significantly elevated mortality risk (Poor Health: Adjusted HR: 3.05; 95% CI: 2.61-4.69; Fair Health: Adjusted HR: 1.83; 95% CI: 1.43-2.35) as compared to women with good health status.

CONCLUSIONS

Self-reported psychological distress and fair and poor self-rated health are associated with reduced survival times among women with breast cancer diagnoses.

The impact of leisure time physical activity on mental health and health perception among people with cancer

Background: People with cancer often report high levels of negative psychological symptoms and poor perception of health due to cancer treatment and activity limitations. Prior studies have suggested that participation in leisure time physical activity (LTPA) can reduce negative psychological symptoms and improve health perception. However, a few studies have examined the contribution of LTPA to health benefits among people with cancer. Thus, we aimed to examine how a different level of LTPA engagement contributed to mental health and health perceptions among people with cancer.

Methods: Using the 2017 Health Information National Trends Survey (HINTS) data, cross sectional data of 504 respondents diagnosed with any types of 22 cancers listed in the survey questionnaire were analyzed. A multivariate analysis of variance (MANOVA) was used to test for mean differences in mental health and health perception among the three different LTPA groups(i.e., inactive, moderately active, and vigorously active groups).

Results: Results indicated that people with cancer who reported higher levels of LTPA scored higher on mental health and health perception than those with lower levels of LTPA (Pillai’s trace= 0.060, F (4,944) = 15.06, P < 0.001).

Conclusion: This finding suggests that individuals with cancer gained more health benefits through high engagement in LTPA. Moreover, we suggested that LTPA can be used as an important therapeutic intervention to promote health quality and wellbeing among people with cancer. Implications for practical suggestions are further discussed.

Accelerated aging in breast cancer survivors and its association with mortality and cancer recurrence

PURPOSE

To prospectively investigate accelerated aging and its association with total mortality and breast cancer-specific mortality/recurrence among breast cancer survivors.

METHODS

This study included 4218 female breast cancer patients enrolled into a population-based cohort study approximately 6-month post-diagnosis. Information on aging-related symptoms (i.e., self-rated overall health condition, energy level, depression, sleep difficulty, and quality) was collected at 18- and 36-month post-diagnosis surveys. Information on overall health, daily function impairments, survival status, and recurrence was collected at 10-year post-diagnosis survey. Record linkages with vital statistics were conducted to collect mortality information. Cox proportional hazards model was applied.

RESULTS

Among 3041 10-year survivors with a mean age of 63.7 ± 9.7 years, respectively, 52.3%, 19.0%, and 27.6% reported poor health, limitation in daily activity, and climbing floors. Age-specific prevalence revealed that breast cancer survivors reached similar prevalence of the functional limitations 5-10 years earlier than cancer-free women. At the 18-month post-diagnosis survey, respectively, 47.0%, 72.5%, and 25.1% of survivors reported unsatisfied overall health condition, reduced energy level, and depression symptoms. After a median follow-up of 10.9 years, low self-rated overall health, low energy level, and depression were significantly associated with increased total mortality, with hazard ratios (HRs; 95% confidence intervals [CI]) of 3.14 (2.43, 4.06), 1.49 (1.20, 1.84), and 1.59 (1.21, 2.09), respectively. Low self-rated health was associated with breast cancer-specific mortality/recurrence (HR  1.85, 95% CI 1.30, 2.65). No significant association was found for sleep difficulty and quality.

CONCLUSION

Aging-related physical changes/symptoms are commonly presented at 18 months after breast cancer diagnosis and are associated with worse prognosis.

IMPACT

Our findings highlight the concern of accelerated aging among breast cancer survivors.

Long-term treatment for emotional distress in women with breast cancer

PURPOSE

Breast cancer patients have many needs, including strategies to cope with the associated distress, during and after cancer treatment. Establishing and implementing adequate social and emotional support for these women, to reduce the detrimental effects of stress resulting from their treatment and disease, is the need of the hour. This study aims to assess how women, diagnosed and treated for breast cancer, combat emotional stress using mechanisms of coping and control and emotional defense, as well as to identify potential groups among them, with different long-term patterns and needs.

METHODS

98 patients belonging to a local breast cancer support association (ALMOM), were enrolled in this study. A questionnaire specifically designed for them was administered, and its internal consistency and reliability assessed. A hierarchical clustering was employed to classify the women. The questionnaire focused on four sections, including personal feelings, coping strategies, environmental influences and maladaptive coping.

RESULTS

An adequate internal reliability was obtained with Cronbach's α near or greater than 0.60. Personal feelings were significant and clearly correlated with coping strategies and maladaptive coping. Three groups of women with different patterns of emotional characteristics and needs were identified: positivist, unsafe, and hopeless women, with different long-term emotional needs to be satisfied.

CONCLUSIONS

Psychological therapeutic interventions should be maintained in many breast cancer patients over time, even after treatment completion, in order to consolidate adaptive and sustainable responses.

Self-reported major mobility disability and mortality among cancer survivors

OBJECTIVE

To quantify the prevalence of self-reported major mobility disability (SR-MMD) and its association with mortality in a nationally-representative sample of cancer survivors.

MATERIALS AND METHODS

This study included patients with a history of cancer who participated in the National Health and Nutrition Examination Survey 19992010. SR-MMD was defined as self-reported difficulty or inability to walk a quarter of a mile. Vital status through December 15, 2011 was ascertained from the United States National Center for Health Statistics. Multivariable-adjusted Cox regression models were used to quantify the hazard ratio (HR) and 95% confidence interval (CI) between SR-MMD and mortality.

RESULTS

The study included 1458 cancer survivors who averaged 67.1 years of age. At baseline, 201 (13.7%) participants had SR-MMD. During a median follow-up of 4.7 years, 434 (29.8%) participants died. SR-MMD was independently associated with a higher risk of all-cause mortality [HR: 2.15 (95% CI: 1.56-2.97); P < 0.001] and cancer-specific mortality [HR: 2.49 (95% CI: 1.53-4.07); P < 0.001]. The association between SR-MMD and all-cause mortality was not modified by age, sex, time since cancer diagnosis, body mass index, or comorbid health conditions.

CONCLUSION

SR-MMD is an easily ascertainable metric of physical function that is associated with a higher risk of mortality among cancer survivors. Integrating measures of physical function may help to guide clinical decision-making and improve long-term prognostication in this population. Interventions that prevent the development of SR-MDD, such as physical activity, should be evaluated in this population.

Health-Related Quality of Life in a Predictive Model for Mortality in Older Breast Cancer Survivors

OBJECTIVES

To develop a predictive model and risk score for 10-year mortality using health-related quality of life (HRQOL) in a cohort of older women with early-stage breast cancer.

DESIGN

Prospective cohort.

SETTING

Community.

PARTICIPANTS

U.S. women aged 65 and older diagnosed with Stage I to IIIA primary breast cancer (N=660).

MEASUREMENTS

We used medical variables (age, comorbidity), HRQOL measures (10-item Physical Function Index and 5-item Mental Health Index from the Medical Outcomes Study (MOS) 36-item Short-Form Survey; 8-item Modified MOS Social Support Survey), and breast cancer variables (stage, surgery, chemotherapy, endocrine therapy) to develop a 10-year mortality risk score using penalized logistic regression models. We assessed model discriminative performance using the area under the receiver operating characteristic curve (AUC), calibration performance using the Hosmer-Lemeshow test, and overall model performance using Nagelkerke R² (NR).

RESULTS

Compared to a model including only age, comorbidity, and cancer stage and treatment variables, adding HRQOL variables improved discrimination (AUC 0.742 from 0.715) and overall performance (NR 0.221 from 0.190) with good calibration (p=0.96 from HL test).

CONCLUSION

In a cohort of older women with early-stage breast cancer, HRQOL measures predict 10-year mortality independently of traditional breast cancer prognostic variables. These findings suggest that interventions aimed at improving physical function, mental health, and social support might improve both HRQOL and survival.

Self-rated health as a predictor of mid-term and long-term mortality in older Afro-Caribbeans hospitalised via the emergency department

PURPOSE

To determine whether self-rated health (SRH) is an independent predictor for mortality in older Afro-Caribbean patients hospitalised for an acute condition.

METHODS

Prospective cohort of patients recruited from the University Hospitals of Martinique Acute Care for Elders unit. Patients aged 75 or older and hospitalised for an acute condition were eligible. The outcome was time to death within the 36-week follow-up. SRH was the explanatory variable of interest. Cox's Proportional Hazards model was used to estimate the relationship between SRH and mortality.

RESULTS

The 223 patients included in the study were aged 85.1 ± 5.5 years. In total, 123 patients reported "very good to good" health, and 100 "medium to very poor" health. Crude mortality rates at six months, 1, 2, and 3 years were 30.5, 34.8, 48.4, and 57.0%, respectively. By multivariate analysis, SRH reached significant relationship for all mortality timepoints. The adjusted hazard ratios for subjects who perceived their health as medium, poor or very poor was 1.6-2.7 times greater than that of subjects who reported good or very good health.

CONCLUSION

Assessment of SRH could have implications for clinical practice, particularly in helping practitioners to better estimate prognosis in the acute care settings.

Quality of Life in Women With Breast Cancer Treated With or Without Chemotherapy

BACKGROUND

The diagnosis and treatment of breast cancer may negatively affect the quality of life (QOL) of women.

OBJECTIVES

The aim of this study is to assess QOL in women with breast cancer who were treated with or without chemotherapy and to identify factors associated with improved or worsening QOL in these women.

METHODS

This cross-sectional study enrolled 112 women who were treated with chemotherapy (CTX group, with 85 [75.9%] women) or without chemotherapy (non-CTX group, with 27 [24.1%] women) for breast cancer. The Short-Form Health Survey (SF-36) assessed QOL and the Hospital Anxiety and Depression scale assessed anxiety and depression.

RESULTS

The overall mean SF-36 score was below 50 in all domains. Relative to CTX women, non-CTX women were significantly older (P = .001) and more likely to engage in physical exercise (P = .002). The non-CTX group had higher scores in the Physical Functioning (P = .001) and Role-Physical (P = .0009) domains of the SF-36 relative to the CTX group, and the fluoruracil + epirubicin + cyclophosphamide group had significantly lower scores in the SF-36 domains Physical Functioning (P = .009) and Role-Physical (P = .02).

CONCLUSION

Chemotherapy treatment for breast cancer worsens QOL in the Physical Functioning and the Role-Physical domains of the SF-36 relative to women treated without chemotherapy.

IMPLICATIONS FOR PRACTICE

Nurses should assess Physical Functioning and the Role-Physical before treatment, as a woman who was not physically active before breast cancer is not likely to become physically active after treatment. Establishing support groups and providing educational sessions about the disease and its management, supportive care can improve the QOL of this population.

Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance)

PURPOSE

Breast cancer patients aged 65+ ("older") vary in frailty status. We tested whether a deficits accumulation frailty index predicted long-term mortality.

METHODS

Older patients (n = 1280) with non-metastatic, invasive breast cancer were recruited from 78 Alliance sites from 2004 to 2011, with follow-up to 2015. Frailty categories (robust, pre-frail, and frail) were based on 35 baseline illness and function items. Cox proportional hazards and competing risk models were used to calculate all-cause and breast cancer-specific mortality for up to 7 years, respectively. Potential covariates included demographic, psychosocial, and clinical factors, diagnosis year, and care setting.

RESULTS

Patients were 65-91 years old. Most (76.6%) were robust; 18.3% were pre-frail, and 5.1% frail. Robust patients tended to receive more chemotherapy ± hormonal therapy (vs. hormonal) than pre-frail or frail patients (45% vs. 37 and 36%, p = 0.06), and had the highest adherence to hormonal therapy. The adjusted hazard ratios for all-cause mortality (n = 209 deaths) were 1.7 (95% CI 1.2-2.4) and 2.4 (95% CI 1.5-4.0) for pre-frail and frail versus robust women, respectively, with an absolute mortality difference of 23.5%. The adjusted hazard of breast cancer death (n-99) was 3.1 (95% CI 1.6-5.8) times higher for frail versus robust patients (absolute difference of 14%). Treatment differences did not account for the relationships between frailty and mortality.

CONCLUSIONS

Most older breast cancer patients are robust and could consider chemotherapy where otherwise indicated. Patients who are frail or pre-frail have elevated long-term all-cause and breast cancer mortality. Frailty indices could be useful for treatment decision-making and care planning with older patients.

Motivation and mortality in older women with early stage breast cancer: A longitudinal study with ten years of follow-up

OBJECTIVES

The Getting Out of Bed Scale (GOB) was validated as a health-related quality of life (HRQoL) variable in older women with early stage breast cancer, suggesting its potential as a concise yet powerful measure of motivation. The aim of our project was to assess the association between GOB and mortality over 10years of follow-up.

MATERIALS AND METHODS

We studied 660 women ≥65-years old diagnosed with stage I-IIIA primary breast cancer. Data were collected over 10years of follow-up from interviews, medical records, and death indexes.

RESULTS

Compared to women with lower GOB scores, women with higher GOB had an unadjusted hazard ratio (HR) of all-cause mortality of 0.78 at 5years, 95% confidence interval (CI) (0.52, 1.19) and 0.77 at 10years, 95%CI (0.59, 1.00). These associations diminished after adjusting for age and stage of breast cancer, and further after adjusting for other HRQoL variables including physical function, mental health, emotional health, psychosocial function, and social support. Unadjusted HRs of breast cancer-specific mortality were 0.92, 95%CI (0.49, 1.74), at 5years, and 0.82, 95%CI (0.52, 1.32), at 10years. These associations also decreased in adjusted models.

CONCLUSION

Women with higher GOB scores had a lower hazard of all-cause mortality in unadjusted analysis. This effect diminished after adjusting for confounding clinical and HRQoL variables. GOB is a measure of motivation that may not be independently associated with cancer mortality, but reflects other HRQoL variables making it a potential outcome to monitor in older patients with cancer.

Role of Non-hepatic Medical Comorbidity and Functional Limitations in Predicting Mortality in Patients with HCV

BACKGROUND

Medical comorbidities and functional status limitations are determinants of mortality in many chronic diseases. The extent to which survival in the rapidly aging cohort of patients with HCV is affected by these competing causes of mortality remains unclear.

AIM

We sought to determine the effect of medical/functional comorbidities on survival after adjusting for liver disease severity in a cohort of patients with HCV infection.

METHODS

We prospectively recruited consecutive patients from an HCV clinic 2009-2014. We calculated an index of survival (Schonberg Index, SI) based on age, gender, medical comorbidities, and functional status variables. We defined cirrhosis with the FibroSure test (F3/4-F4). We used multivariable Cox modeling to assess association between functional/survival measure and survival after adjustment for severity of liver disease.

RESULTS

The cohort consisted of 1052 HCV patients. The average age was 56.8 years; 36 % had cirrhosis. The mean SI was 8.2 (SD = 2.7). During a mean follow-up of 5610 person-years, 102 (9.7 %) patients died. In unadjusted analysis, higher baseline SI predicted mortality (HR 1.17; 95 % CI 1.09-1.25). SI similarly predicted mortality in cirrhotic patients (HR 1.23, 95 % CI 1.13-1.34) and non-cirrhotic patients (HR 1.21, 95 % CI 1.08-1.36). This did not change after adjusting for age, drug use, or coronary artery disease.

DISCUSSION

Comorbidities and functional limitations predict higher mortality in patients with HCV; this relationship is independent of cirrhosis. Use of general prognostic indices may help identify HCV patients at high risk for mortality, which could further guide clinical care in a manner not achievable with assessment of liver disease alone.

Is self-rated health an independent prognostic factor of six-week mortality in older patients hospitalized for an acute condition?

PURPOSE

To determine whether self-rated health is a prognostic factor of six-week mortality, independently of other known objective prognostic factors.

METHODS

The SAFMA study was a prospective cohort, which recruited patients from the University Hospital of Martinique Acute Care for Elders unit (French West Indies) from January to June 2012. Patients aged 75 or older and hospitalized for an acute condition were eligible. The outcome was time to death within the six-week follow-up. The main explanatory variable was self-rated health. Sociodemographic and clinical characteristics were considered as covariates. Cox's proportional hazards model was used.

RESULTS

The mean age of the 223 patients included was 85.1 ± 5.5 years. Six-week mortality rate was 14.8 %; none were lost to follow-up. In total, 123 claimed "very good to good" health, and 100 "medium to very poor" health. Self-rated health was the only independent prognostic factor associated with 6-week mortality (hazard ratio 2.61; 95 % confidence interval 1.18-5.77; p = .02), when adjusting for known prognostic factors such as age, dimensions of the comprehensive geriatric assessment and comorbidity burden.

CONCLUSION

The association between self-rated health and short-term mortality could have implications for clinical practice, particularly in helping in the estimation of prognosis in acute care setting.