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Senteio C, Murdock PJ. The Efficacy of Health Information Technology in Supporting Health Equity for Black and Hispanic Patients With Chronic Diseases: Systematic Review. J Med Internet Res 2022; 24:e22124. [PMID: 35377331 PMCID: PMC9016513 DOI: 10.2196/22124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/25/2020] [Accepted: 01/23/2022] [Indexed: 12/26/2022] Open
Abstract
Background Racial inequity persists for chronic disease outcomes amid the proliferation of health information technology (HIT) designed to support patients in following recommended chronic disease self-management behaviors (ie, medication behavior, physical activity, and dietary behavior and attending follow-up appointments). Numerous interventions that use consumer-oriented HIT to support self-management have been evaluated, and some of the related literature has focused on racial minorities who experience disparate chronic disease outcomes. However, little is known about the efficacy of these interventions. Objective This study aims to conduct a systematic review of the literature that describes the efficacy of consumer-oriented HIT interventions designed to support self-management involving African American and Hispanic patients with chronic diseases. Methods We followed an a priori protocol using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-Equity 2012 Extension guidelines for systematic reviews that focus on health equity. Themes of interest included the inclusion and exclusion criteria. We identified 7 electronic databases, created search strings, and conducted the searches. We initially screened results based on titles and abstracts and then performed full-text screening. We then resolved conflicts and extracted relevant data from the included articles. Results In total, there were 27 included articles. The mean sample size was 640 (SD 209.5), and 52% (14/27) of the articles focused on African American participants, 15% (4/27) of the articles focused on Hispanic participants, and 33% (9/27) included both. Most articles addressed 3 of the 4 self-management behaviors: medication (17/27, 63%), physical activity (17/27, 63%), and diet (16/27, 59%). Only 15% (4/27) of the studies focused on follow-up appointment attendance. All the articles investigated HIT for use at home, whereas 7% (2/27) included use in the hospital. Conclusions This study addresses a key gap in research that has not sufficiently examined what technology designs and capabilities may be effective for underserved populations in promoting health behavior in concordance with recommendations.
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Affiliation(s)
- Charles Senteio
- Department of Library and Information Science, School of Communication and Information, Rutgers University, New Brunswick, NJ, United States
| | - Paul Joseph Murdock
- Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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Klein WMP. Behavioral medicine, cancer control, and NCI: reflections on a fruitful past and auspicious future. Transl Behav Med 2021; 11:2065-2069. [PMID: 34850930 DOI: 10.1093/tbm/ibab131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cancer prevention and control has benefited substantially from behavioral medicine research over the last several decades. The National Cancer Institute's (NCI) Division of Cancer Control and Population Sciences, ably led by Barbara Rimer and then Bob Croyle since being established in 1997, has been a primary supporter of this research. NCI has made significant investments in many of the topics featured in this special section and will continue to do so. These include research on basic behavioral processes such as affect as well as optimal approaches to health communication. A key and enduring focus has been the support of behavioral interventions, particularly for tobacco, diet, physical activity, and sun exposure. The success of such interventions will be amplified to the extent that they leverage novel research designs, emerging digital technologies, evidence gleaned from the burgeoning field of implementation science, and lessons learned from greater attention to the impact of health disparities and inequities. Moreover, as the cancer survivor population continues to grow given the rapid development of diagnostic and therapeutic science, it will be even more essential to devote attention to understanding and addressing the health care and other needs of survivors such as cognitive dysfunction and financial toxicity. The field of behavioral medicine should be both applauded for its many contributions to reducing the cancer burden and encouraged to continue developing new research ideas in these critical areas.
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Affiliation(s)
- William M P Klein
- Behavioral Research Program, National Cancer Institute, Bethesda, MD 20892, USA
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Rethinking physical activity assessment in cancer survivors: a multi-component approach using NHANES data. J Cancer Surviv 2021; 16:781-790. [PMID: 34110584 DOI: 10.1007/s11764-021-01072-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/05/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE To confirm that a multi-component physical activity index (PAI), with physical activity (PA)-related behaviors and performance measures, enhances PA assessment for adults with cancer history ("survivors") vs. for the general population for key health variables. METHODS Data from 2011 to 2014 NHANES were analyzed (n = 9620 adults, including 866 survivors). We generated PAI scores by calculating subscales for activity-related behaviors (i.e., moderate-to-vigorous PA and TV viewing hours/sedentary time) (n/8) and performance (i.e., cardiorespiratory fitness and muscle strength) (n/8), then combined for an overall PAI score (n/16 points). Dependent variables (self-reported health, multimorbidity, and functional limitations) were dichotomized and tested with logistic regression to estimate associations with PAI variables. RESULTS Survivors obtaining 22.5 + MET hours/week of PA were >5× more likely to report excellent health than non-exercisers (OR = 5.5, 95% CI 3.27-9.28). We observed a general decrease in likelihood of multimorbidity and functional limitations with increasing PA. Models with the combined score showed that higher PAI scores had larger positive associations with all three for all adults. Survivors with higher PAI scores were >30% more likely to report excellent self-rated health (OR = 1.3, 95% CI 1.2-1.4) and 20% less likely to report multimorbidity and functional limitations compared to survivors with lower PAI scores, considering covariates. CONCLUSIONS Greater PA-related behavior and performance was beneficial for adults irrespective of cancer history. However, using a combined score elucidates unique needs and benefits for survivors vs. for general population. IMPLICATIONS FOR CANCER SURVIVORS Using a multi-component approach to PA assessment could help in developing validated tools to plan exercise programs and interventions for survivors.
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Gallicchio L, Tonorezos E, de Moor JS, Elena J, Farrell M, Green P, Mitchell SA, Mollica MA, Perna F, Gottlieb Saiontz N, Zhu L, Rowland J, Mayer DK. Evidence Gaps in Cancer Survivorship Care: A Report from the 2019 National Cancer Institute Cancer Survivorship Workshop. J Natl Cancer Inst 2021; 113:1136-1142. [PMID: 33755126 DOI: 10.1093/jnci/djab049] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 12/26/2022] Open
Abstract
Today, there are more than 16.9 million cancer survivors in the United States; this number is projected to grow to 22.2 million by 2030. While much progress has been made in understanding cancer survivors needs and in improving survivorship care since the seminal 2006 Institute of Medicine report From Cancer Patient to Cancer Survivor: Lost in Transition, there is a need to identify evidence gaps and research priorities pertaining to cancer survivorship. Thus, in April 2019, the National Cancer Institute convened grant-funded extramural cancer survivorship researchers, representatives of professional organizations, cancer survivors, and advocates for a one-day in-person meeting. At this meeting, and in a subsequent webinar aimed at soliciting input from the wider survivorship community, evidence gaps and ideas for next steps in the following six areas, identified from the 2006 Institute of Medicine report, were discussed: surveillance for recurrence and new cancers, management of long-term and late physical effects, management of long-term and late psychosocial effects, health promotion, care coordination, and financial hardship. Identified evidence gaps and next steps across the areas included the need to understand and address disparities among cancer survivors, to conduct longitudinal studies as well as longer-term (>5 years post-diagnosis) follow-up studies, to leverage existing data, and to incorporate implementation science strategies to translate findings into practice. Designing studies to address these broad evidence gaps, as well as those identified in each area, will expand our understanding of cancer survivors' diverse needs, ultimately leading to the development and delivery of more comprehensive evidence-based quality care.
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Affiliation(s)
- Lisa Gallicchio
- Clinical and Translational Epidemiology Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Emily Tonorezos
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Janet S de Moor
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Joanne Elena
- Clinical and Translational Epidemiology Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Margaret Farrell
- Division of Communications and Marketing, Office of the Director, National Institutes of Health
| | - Paige Green
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Sandra A Mitchell
- Outcomes Research Branch, Health Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Michelle A Mollica
- Outcomes Research Branch, Health Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Frank Perna
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Nicole Gottlieb Saiontz
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Li Zhu
- Statistical Research and Applications Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Julia Rowland
- Smith Center for Healing and the Arts, Washington DC
| | - Deborah K Mayer
- School of Nursing, University of North Carolina at Chapel Hill; University of North Carolina Lineberger Comprehensive Cancer Center
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Bluethmann SM, Flores E, Campbell G, Klepin HD. Mobility Device Use and Mobility Disability in U.S. Medicare Beneficiaries With and Without Cancer History. J Am Geriatr Soc 2020; 68:2872-2880. [PMID: 32971567 PMCID: PMC8347693 DOI: 10.1111/jgs.16789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES To examine the prevalence of mobility device use in U.S. community-dwelling older adults including older adults with cancer history ("survivors") and to estimate mobility disability noting variation by cancer history, cancer site, and other factors to improve early detection of mobility limitations. DESIGN Cross-sectional analysis from the 2011 National Health and Aging Trends Study. SETTING In-person interviews in the homes of study participants. PARTICIPANTS Nationally representative sample of community-dwelling Medicare beneficiaries, aged 65 and older (n = 6,080 including 1,203 survivors). MEASUREMENTS Participants were asked about cancer history, pain that limited activity, mobility device use (eg, canes, walkers, wheelchairs, and scooters), history of falls, and medical conditions plus they were assessed for approximate mobility disability using a 3-m gait speed test. The results were scored on a scale of 0 to 4 (0 = lowest, 4 = highest) using criteria from the National Institute on Aging. RESULTS A total of 19% of older adults and 23% of survivors reported using one or more mobility device, most commonly a single-point cane. Approximately 10% of breast, 6% of prostate, and 3% of colorectal cancer survivors reported using two or more devices in the past month. Survivors had lower mean gait speed scores (2.27) than adults without cancer history (2.39). In regression models, survivors were 18% less likely than adults without cancer history to score high on the gait speed test (odds ratio = .82; P < .05). Prior mobility device use, history of multiple falls, unhealthy weight, Black race, multimorbidity, and pain that limited activity were associated with lower gait speed scores in all participants (all P < .05). CONCLUSION A greater proportion of older survivors used mobility devices than adults without cancer history. Mobility device use varied by cancer site and was highest in survivors of breast, colorectal, and gynecological cancer. Survivors were also more likely to show signs of mobility disability, based on gait speed, compared with adults without cancer history. These indications, although modest, suggest that older survivors may require special attention to functional changes in survivorship.
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Affiliation(s)
- Shirley M. Bluethmann
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA
| | - Eileen Flores
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA
| | - Grace Campbell
- School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Heidi D. Klepin
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC
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Cairo J, Williams L, Bray L, Goetzke K, Perez AC. Evaluation of a Mobile Health Intervention to Improve Wellness Outcomes for Breast Cancer Survivors. J Patient Cent Res Rev 2020; 7:313-322. [PMID: 33163551 DOI: 10.17294/2330-0698.1733] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose Breast cancer survivors are at increased risk of cancer recurrence, second malignancies, and other comorbid conditions. This study examined if use of a convenient, commercially available, $65 per month app that gives breast cancer survivors access to a health and wellness coach is more effective than a self-guided toolkit and one-time health education session at achieving the following goals: 1) improving adherence to a plant-based diet, 2) increasing physical activity, 3) assisting with weight loss and reduction in body mass index, 4) reducing elevated depression and fatigue scores, and 5) leading to sustained adherence to lifestyle and wellness plan at and beyond 6 months. Methods A nonrandomized 2-group control study design with pre-post repeated measures (N=127 subjects) was utilized. Women 18 years of age or older, with curative-intent breast cancer, were included in the study. App users received a survivorship care plan and enrolled in a 6-month subscription to the health app. A control group received the same information but, instead of access to the app, were given a self-guided toolkit. Results At 6 months, more patients in the app group experienced weight loss and had a significantly greater reduction in overall body mass index (P<0.01). The app group also demonstrated statistically significant improvements in "strenuous" physical activity (P=0.04) and had significant improvement in their dietary patterns (P<0.001), as compared to the self-guided group. The app group had greater reduction in fatigue and improvement in depression, but these changes were not statistically significant. At 12 months, none of the app users were still using the app, but many were still following their wellness plan and had maintained their weight loss. Outliers in both groups and low rate of response made evaluation of results difficult. Conclusions The results of this advanced practice provider-led study demonstrated that a live health coaching app that provides wellness coaching can offer motivated breast cancer survivors and cancer programs a modality that offers convenient, effective support at a reasonable cost.
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Affiliation(s)
- Jamie Cairo
- Aurora Cancer Care, Advocate Aurora Health, Milwaukee, WI
| | | | - Lisa Bray
- Aurora Cancer Care, Advocate Aurora Health, Milwaukee, WI
| | | | - Ana Cristina Perez
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
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Hirschey R, Nyrop KA, Mayer DK. Healthy Behaviors: Prevalence of Uptake Among Cancer Survivors. Clin J Oncol Nurs 2020; 24:19-29. [PMID: 32945809 DOI: 10.1188/20.cjon.s2.19-29] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although most cancer survivors adhere to recommendations to refrain from tobacco and minimize alcohol use, survivors of certain cancers are not meeting these recommendations. In addition, most cancer survivors do not achieve optimal recommendations for diet and physical activity, further decreasing survivor health and quality of life. Sun protective and sleep behaviors also tend to be suboptimal among survivors. Uptake of age-appropriate vaccinations is variable among survivors. OBJECTIVES The purpose of this article is to review the prevalence of healthy behavior uptake among cancer survivors and provide nurses with an overview of effective interventions, strategies, and resources to help patients improve these behaviors. METHODS An expert panel was convened to conduct an integrative review and synthesis on the state of the science of healthy behavior uptake among cancer survivors. FINDINGS Not meeting recommendations for healthy lifestyle behaviors increases the risk of second cancers and mortality and decreases overall health and quality of life. Healthy lifestyle behaviors can contribute to improved function, quality of life, and overall survival for cancer survivors. Nurses can help survivors to understand and improve their behaviors.
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Ramsey SD, Hall IJ, Smith JL, Ekwueme DU, Fedorenko CR, Kreizenbeck K, Bansal A, Thompson IM, Penson DF. A comparison of general, genitourinary, bowel, and sexual quality of life among long term survivors of prostate, bladder, colorectal, and lung cancer. J Geriatr Oncol 2020; 12:305-311. [PMID: 32739353 DOI: 10.1016/j.jgo.2020.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Studies of local stage prostate cancer survivors suggest that treatments carry risk of persistent impotence, incontinence, and bowel dysfunction. To examine impacts of cancer type and side effects on health-related quality of life (HRQoL) in long-term cancer survivorship, we evaluated 5-year follow-up of patients with prostate cancer and compared results with a matched group of male long-term survivors of other local-stage cancers. MATERIALS AND METHODS We examined genitourinary, bowel and sexual symptoms, and general quality of life. Matched survivors of colorectal, lung, and bladder cancers were recruited via registries in 3 different regions in the United States. Patients were surveyed 3-5 years after diagnosis with the SF-12 and EPIC to evaluate general mental and physical health-related quality of life (HRQoL) and patient function and bother. RESULTS We analyzed responses from long-term prostate (n = 77) and bladder, colorectal, and lung cancer (n = 124) patients. In multivariate analysis, long-term local stage prostate cancer survivors had significantly higher SF-12 physical component scores but did not differ from long-term survivors of other cancers in terms of their SF-12 mental summary scores. Prostate survivors had similar mental, urinary, bowel, and sexual HRQoL compared to long-term survivors of other local stage cancers. CONCLUSION Long-term general and prostate-specific HRQoL was similar between local stage prostate and bladder, colorectal, and lung patients with cancer. Future research focusing on factors other than initial treatment and the cancer type per se may provide more meaningful information regarding factors that predict disparities on HRQoL among longer-term survivors of early stage male cancers.
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Affiliation(s)
- Scott D Ramsey
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MS: M3-B232, Seattle, WA 98109-1024, USA.
| | - Ingrid J Hall
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F76, Chamblee, GA 30341, USA.
| | - Judith Lee Smith
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F76, Chamblee, GA 30341, USA.
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F76, Chamblee, GA 30341, USA.
| | - Catherine R Fedorenko
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MS: M3-B232, Seattle, WA 98109-1024, USA.
| | - Karma Kreizenbeck
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MS: M3-B232, Seattle, WA 98109-1024, USA.
| | - Aasthaa Bansal
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MS: M3-B232, Seattle, WA 98109-1024, USA; University of Washington, Department of Pharmacy, University of Washington, Box 357630, Seattle, WA 98195, USA.
| | - Ian M Thompson
- University of Texas Health Science Center, 7979 Wurzbach Rd, San Antonio, TX 78229, USA; Christus Santa Rosa Hospital and Medical Center, 2827 Babcock Rd, San Antonio, TX 78229, USA.
| | - David F Penson
- Department of Urology and Department of Preventive Medicine, University of Southern California/Norris Cancer Center, 1441 Eastlake Ave, Los Angeles, CA 90033, USA; Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA.
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Corbett T, Cummings A, Calman L, Farrington N, Fenerty V, Foster C, Richardson A, Wiseman T, Bridges J. Self‐management in older people living with cancer and multi‐morbidity: A systematic review and synthesis of qualitative studies. Psychooncology 2020; 29:1452-1463. [DOI: 10.1002/pon.5453] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Teresa Corbett
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- NIHR ARC Wessex University of Southampton UK
| | - Amanda Cummings
- Macmillan Survivorship Research Group University of Southampton Southampton UK
| | - Lynn Calman
- Macmillan Survivorship Research Group University of Southampton Southampton UK
| | - Naomi Farrington
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- University Hospital Southampton NHS Foundation Trusts Southampton UK
| | - Vicky Fenerty
- University of Southampton Library University of Southampton Southampton UK
| | - Claire Foster
- Macmillan Survivorship Research Group University of Southampton Southampton UK
| | - Alison Richardson
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- NIHR ARC Wessex University of Southampton UK
- University Hospital Southampton NHS Foundation Trusts Southampton UK
| | - Theresa Wiseman
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- The Royal Marsden NHS Foundation Trust London UK
| | - Jackie Bridges
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- NIHR ARC Wessex University of Southampton UK
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Physical Activity in Older Cancer Survivors: What Role Do Multimorbidity and Perceived Disability Play? J Aging Phys Act 2020; 28:311-319. [PMID: 31693992 DOI: 10.1123/japa.2019-0086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/01/2019] [Accepted: 08/08/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE (a) To describe the relationship of multimorbidity and physical activity (PA) in cancer survivors and (b) to explore perceived disability and PA in middle-aged and older survivors. METHODS The authors analyzed the data from cancer survivors (N = 566), identified using the Pennsylvania Cancer Registry, who responded to a Behavioral Risk Factor Surveillance System-derived questionnaire. They created age groups (e.g., 45-54 years, 55-64 years, 65-74 years, and 75 years and older) and calculated a composite score of eight common comorbidities (e.g., chronic obstructive pulmonary disease, heart disease) to assess multimorbidity. Logistic regression was used to estimate the association of demographic and behavioral/clinical risk factors (e.g., multimorbidity, perceived disability, body mass index) with PA. RESULTS Most respondents were females (62%), older (mean age = 68 years) and represented diverse cancer sites, including breast (n = 132), colorectal (n = 102), gynecologic (n = 106), prostate (n = 111), and lung (n = 80). PA participation was mixed; 44% of survivors reported achieving >150 min of aerobic PA, but half of lung and 37% of gynecologic survivors reported no PA (0 min/week). Higher multimorbidity (odds ratio = 0.82, confidence interval [0.69, 0.98], p < .05), obesity (odds ratio = 0.51, confidence interval [0.30, 0.86], p < .05), and perceived disability (odds ratio = 0.49, confidence interval [0.32, 0.77], p < .001) were negatively associated with PA participation. Strength training was suboptimal across all survivors. CONCLUSION Most older survivors experienced comorbid conditions, and this was associated with less PA. Survivors who perceived themselves as disabled or who were obese were half as likely as others to participate in PA. This suggests an increasing need to address both physical and psychological limitations in designing PA interventions for real-world needs. Exercise interventions that address the unique needs of older survivors for multimorbidity, obesity, and perceived disability may strengthen opportunities for PA.
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DeSantis CE, Miller KD, Dale W, Mohile SG, Cohen HJ, Leach CR, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for adults aged 85 years and older, 2019. CA Cancer J Clin 2019; 69:452-467. [PMID: 31390062 DOI: 10.3322/caac.21577] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Adults aged 85 years and older, the "oldest old," are the fastest-growing age group in the United States, yet relatively little is known about their cancer burden. Combining data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the National Center for Health Statistics, the authors provide comprehensive information on cancer occurrence in adults aged 85 years and older. In 2019, there will be approximately 140,690 cancer cases diagnosed and 103,250 cancer deaths among the oldest old in the United States. The most common cancers in these individuals (lung, breast, prostate, and colorectum) are the same as those in the general population. Overall cancer incidence rates peaked in the oldest men and women around 1990 and have subsequently declined, with the pace accelerating during the past decade. These trends largely reflect declines in cancers of the prostate and colorectum and, more recently, cancers of the lung among men and the breast among women. We note differences in trends for some cancers in the oldest age group (eg, lung cancer and melanoma) compared with adults aged 65 to 84 years, which reflect elevated risks in the oldest generations. In addition, cancers in the oldest old are often more advanced at diagnosis. For example, breast and colorectal cancers diagnosed in patients aged 85 years and older are about 10% less likely to be diagnosed at a local stage compared with those diagnosed in patients aged 65 to 84 years. Patients with cancer who are aged 85 years and older have the lowest relative survival of any age group, with the largest disparities noted when cancer is diagnosed at advanced stages. They are also less likely to receive surgical treatment for their cancers; only 65% of breast cancer patients aged 85 years and older received surgery compared with 89% of those aged 65 to 84 years. This difference may reflect the complexities of treating older patients, including the presence of multiple comorbidities, functional declines, and cognitive impairment, as well as competing mortality risks and undertreatment. More research on cancer in the oldest Americans is needed to improve outcomes and anticipate the complex health care needs of this rapidly growing population.
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Affiliation(s)
- Carol E DeSantis
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Kimberly D Miller
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - William Dale
- Department of Supportive Care Medicine, Center for Cancer and Aging, City of Hope National Medical Center, Duarte, California
| | - Supriya G Mohile
- Wilmot Cancer Center, Geriatric Oncology Research Program, University of Rochester Medical Center, Rochester, New York
| | - Harvey J Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | - Corinne R Leach
- Behavioral and Epidemiology Research, American Cancer Society, Atlanta, Georgia
| | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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