Association between self-perception of aging, view of cancer and health of older patients in oncology: a one-year longitudinal study

Real-world overview of therapeutic strategies and prognosis of older patients with advanced or metastatic non-small cell lung cancer from the ESME database

INTRODUCTION

In France, 40% of patients diagnosed with lung cancer are ≥70 years old, but these are under-represented in clinical trials. Using data from the French Epidemiological Strategy and Medical Economics (ESME) platform on Lung Cancer (LC), the objective is to provide an overview of the management and the prognosis of older patients with advanced or metastatic non-small cell lung cancer (AM-NSCLC) in a real-world context.

MATERIALS AND METHODS

From the ESME-LC database, we selected patients with AM-NSCLC (stage IIIB, IIIC, and IV), diagnosed between 2015 and 2019, and who received first-line systemic treatment. Demographics, tumour characteristics, and treatment received were described in patients ≥70, and compared to younger ones. Real-world progression-free survival (rwPFS) and overall survival (OS) were evaluated using the multivariable Cox model.

RESULTS

Among 10,002 patients with AM-NSCLC, the median age was 64 years, with 2,754 (27.5%) aged ≥70. In comparison with patients <70, older patients were more often male, with worse performance status and more comorbidities, but they were less underweight and more often non-smokers. The proportion of EGFR mutated non-squamous NSCLC was higher in older patients (25.0% vs 12.8%, p < 0.001), particularly among smokers and former smokers (12.7% vs 7.3%, p < 0.001). Among patients ≥70, 76.6% received first-line chemotherapy (including 67.0% treated with a platinum-based doublet), 15.0% received only targeted therapy, and 11.0% received immunotherapy (alone or in combination). Median first-line rwPFS was 5.1 months (95% confidence interval [CI] = [4.8;5.4]) for patients ≥70 and 4.6 months (95%CI = [4.4;4.8]) for patients <70, but age was not associated with rwPFS in multivariable analysis. Median OS was 14.8 months (95%CI = [13.9;16.1]) for patients ≥70 and 16.7 months (95%CI = [15.9;17.5]) for patients <70, with a significant effect of age in multivariable analysis for patients treated with chemotherapy and/or with targeted therapy, but not for patients treated with immunotherapy (alone or in combination with chemotherapy).

DISCUSSION

In this real-world cohort of patients with AM-NSCLC, age was not associated with first-line rwPFS regardless of treatment received, nor with OS for patients receiving immunotherapy. However, OS was significantly shorter for patients aged ≥70 treated with chemotherapy or with targeted therapy alone.

A brief version of the Attitudes to Ageing Questionnaire for older Chinese adults: development and psychometric evaluation

BACKGROUND

Positive attitudes toward aging are considered essential for achieving psychological well-being in later life. However, there is currently a lack of a concise and comprehensive measurement tool specifically designed to assess attitudes toward aging among the elderly population in China. To address this gap, the present study aimed to develop a brief version of the Attitudes to Ageing Questionnaire tailored to older Chinese individuals and evaluate its psychometric properties.

METHODS

Initially, a sample of community-dwelling older adults (Sample 1: n = 442, aged 60-88) was utilized to establish a new scale format. Subsequently, two convenience samples (Sample 2: n = 311, aged 60-90; Sample 3: n = 164, aged 60-89) were employed to evaluate the psychometric properties of this scale, including factor structure, internal consistency, test-retest reliability, convergent validity, and discriminant validity.

RESULTS

We selected 12 items from the original questionnaire to create the brief scale. The brief scale maintained the three-factor structure of the full-format version, encompassing psychosocial loss, physical change, and psychological growth, and demonstrated adequate psychometric properties.

CONCLUSIONS

This development process shortens the administration time of the questionnaire while avoiding excessive loss of information. The newly developed scale serves as a reliable and valid assessment tool for measuring attitudes toward aging among older Chinese individuals and is well-suited for implementation in large-scale surveys that utilize an extensive array of questionnaires. This tool can be applied to assessing the effectiveness of interventions aimed at eliminating ageism.

The Association of Self-Perception of Aging and Quality of Life in Older Adults: A Systematic Review

BACKGROUND AND OBJECTIVES

Self-perception of aging is an important psychosocial factor that can influence quality of life in older age. This review aimed to synthesize findings on the association between self-perception of aging and quality of life among older adults aged 60 and above.

RESEARCH DESIGN AND METHODS

A systematic search was conducted in 4 electronic databases (Ovid Medline, PsycInfo, CINAHL, and Web of Science). Studies conducted in English and including measures on the perception of aging and quality of life were included in this review. A total of 32 observational studies (21 cross-sectional, 8 longitudinal, 2 mixed-method, and 1 qualitative) met the inclusion criteria. Outcomes reported in the included studies were quality of life, physical health and functioning, psychological health, mental health, and general well-being.

RESULTS

Overall, 20 quantitative studies indicated a strong association between positive perception of aging and increased quality of life. Similarly, 9 quantitative studies demonstrated that negative perception of aging is associated with lower quality of life. Results of the mixed-method and qualitative studies indicated that older adults with higher morale and good physical capability had more positive perceptions of health.

DISCUSSION AND IMPLICATIONS

These results suggest that promoting a positive perception of aging and a self-care attitude would help to enhance older adults' quality of life and should be incorporated into future health promotions and interventions.

Using the Multidimensional Health Locus of Control Scale Form C to Investigate Health Beliefs About Bladder Cancer Prevention and Treatment Among Male Patients: Cross-Sectional Study

BACKGROUND

Bladder cancer is a leading cause of death among Chinese male populations in recent years. The health locus of control construct can mediate health status and outcomes, and it has proven helpful in predicting and explaining specific health-related behaviors. However, it has never been used to investigate health beliefs about bladder cancer prevention and treatment.

OBJECTIVE

This study aimed to classify male patients into different latent groups according to their beliefs about bladder cancer prevention and treatment and to identify associated factors to provide implications for the delivery of tailored education and interventions and the administration of targeted prevention and treatment.

METHODS

First, we designed a four-section questionnaire to solicit data: section 1-age, gender, and education; section 2-the communicative subscale of the All Aspects of Health Literacy Scale; section 3-the eHealth Literacy Scale; and section 4-health beliefs about bladder cancer prevention and treatment measured by the Multidimensional Health Locus of Control Scale Form C. We hypothesized that the participants' health beliefs about bladder cancer prevention and treatment measured in section 4 could be closely associated with information collected through sections 1 to 3. We recruited 718 Chinese male patients from Qilu Hospital of Shandong University, China, and invited them to participate in a web-based questionnaire survey. Finally, we used latent class analysis to identify subgroups of men based on their categorical responses to the items on the Multidimensional Health Locus of Control Scale Form C and ascertained factors contributing to the low self-efficacy group identified.

RESULTS

We identified 2 subgroups defined as low and moderate self-efficacy groups representing 75.8% (544/718) and 24.2% (174/718) of the total sample, respectively. Men in the low self-efficacy cluster (cluster 1: 544/718, 75.8%) were less likely to believe in their own capability or doctors' advice to achieve optimal outcomes in bladder cancer prevention and treatment. Men in the moderate self-efficacy cluster (cluster 2: 174/718, 24.2%) had distinct psychological traits. They had stronger beliefs in their own capability to manage their health with regard to bladder cancer prevention and treatment and moderate to high levels of trust in health and medical professionals and their advice to achieve better prevention and treatment outcomes. Four factors contributing to low self-efficacy were identified, including limited education (Year 6 to Year 12), aged ≥44 years, limited communicative health literacy, and limited digital health literacy.

CONCLUSIONS

This was the first study investigating beliefs about bladder cancer prevention and treatment among Chinese male patients. Given that bladder cancer represents a leading cause of death among Chinese male populations in recent years, the low self-efficacy cluster and associated contributing factors identified in this study can provide implications for clinical practice, health education, medical research, and health policy-making.

Longitudinal effects of subjective aging on health and longevity: An updated meta-analysis

This article updates and extends an earlier meta-analysis (Westerhof et al., 2014) on the longitudinal effects of subjective aging (SA) on health outcomes. A systematic search in different databases (APA PsycInfo, PubMed, Web of Science, and Scopus) resulted in 99 articles, reporting on 107 studies. Participants: Studies had a median sample size of 1,863 adults with a median age of 66 years. A randomized effect meta-analysis showed a significant, small effect (likelihood ratio = 1.347; 95% confidence interval [1.300, 1.396]; p < .001), similar in magnitude to the previous meta-analysis of 19 studies. Although the results showed high heterogeneity in the longitudinal link between SA and health outcomes, there were no differences in effects according to chronological age of participants, welfare state status (more or less developed social security system), length of follow-up, type of health-related outcome, or quality of the study. Effects were stronger for multiitem measures of self-perceptions of aging than for the frequently used single-item measures assessing subjective age, especially for indicators of physical health. Based on this meta-analysis, building on five times more studies than the 2014 review, we consider the associations of measures of SA with health and longevity across time as robust, albeit small in size. Future research should concentrate on the clarification of pathways mediating the relation between SA and health outcomes, as well as potential bidirectional effects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The impact of ageism in the care of older adults with cancer

PURPOSE OF REVIEW

This review summarizes recent research on the impact of ageism in older adults with cancer and how society can best address the issue. Despite older individuals representing the vast majority of those with cancer, with a dramatic increase in incidence anticipated in the coming decades, ageism remains an under-recognized and extremely detrimental phenomenon in cancer care.

RECENT FINDINGS

We examine the associations between ageism and health, and highlight the consequences of higher mortality, a deterioration in mental and physical health, worse functional status and increased comorbidity burden. We then discuss the oncologic-specific impacts of ageism, including lower rates of cancer screening, decreased histological confirmation of cancer, decreased surgical intervention and systemic therapy prescription and poorer survivorship experience. To conclude, we illustrate the opportunities within oncologic systems of care to engage with, and dismantle, the damaging effects of ageism, namely policy and legislation, education and intergenerational contact.

SUMMARY

Despite recognition of the numerous negative sequelae of ageism, there remains a paucity of literature regarding the intersection between ageism and cancer. Our piece summarizes the key developments in this field, but further evaluation is desperately required.

Changes in depressive symptoms from pre- to postretirement over a 20-year span: The role of self-perceptions of aging

BACKGROUND

Retirement-related changes in depressive symptoms are not clear. This research examined short- and long-term changes in older adults' depressive symptoms before, upon, and after retirement. It also tested if and how changes in depressive symptoms varied by different levels of negative self-perceptions of aging (nSPA) in men and women.

METHODS

We analyzed longitudinal data from individuals who retired between 1994 and 2016 in the Health and Retirement Study (N = 9027). Using fixed-effect regression models, we examined changes in depressive symptoms from the 10-year preretirement phase through the 10-year postretirement phase. We also examined how changes in depressive symptoms during the retirement transition varied across four groups: low nSPA men, low nSPA women, high nSPA men, and high nSPA women.

RESULTS

Both male and female retirees experienced increased short- and long-term depressive symptoms after retirement. However, the pattern of change varied by nSPA and gender. For both low nSPA men and women, there were no significant changes in depressive symptoms across different retirement phases. Adults with high nSPA showed important changes in depressive symptoms, but there were gender differences-High nSPA men experienced increases in depressive symptoms mainly in preretirement years and during the year of retirement; high nSPA women experienced symptoms increase during the year of retirement and the years after retirement.

LIMITATIONS

The use of self-report measures may lead to recall bias. Studies are needed to understand mechanisms behind the protective role of low nSPA.

CONCLUSIONS

The findings attest to the health benefits of low nSPA during later-life stages.

The Effects of Age Stereotypes on Physical and Mental Health Are Mediated by Self-perceptions of Aging

OBJECTIVES

Although the evidence linking views on aging (VoA) with aging outcomes is robust, little is known about how different types of VoA may interact to influence such outcomes. Therefore, this study examined two types of VoA, age stereotypes (AS), representing general VoA, and self-perceptions of aging (SPA), representing personal VoA. We operationalized SPA in terms of awareness of age-related change (AARC), distinguishing between gain- and loss-related SPA (e.g., awareness of positive and negative age-related changes, respectively). Based on theoretical reasoning, we hypothesized that AS would be an antecedent of SPA, and that the effect of AS on physical and mental health would be mediated by SPA.

METHOD

A total of 819 German and U.S. adults aged 40-98 completed a survey on VoA, physical health, and mental health at baseline and 2.5 years later. Structural equation modeling with latent variables was used to examine the effects of Time 1 AS (predictor) and Time 2 gain- and loss-related SPA (mediators) on physical and mental health outcomes.

RESULTS

As hypothesized, AS predicted later SPA. Loss-related SPA mediated the effect of AS on physical health; both gain- and loss-related SPA mediated the effect of AS on mental health.

DISCUSSION

Congruent with theoretical assumptions, our findings provide empirical support for a directional pathway by which AS shape later SPA. We conclude that AS and SPA may affect physical health outcomes more strongly than mental health outcomes. Studies that assess both types of VoA are needed to illuminate the pathways by which VoA influence aging outcomes.

Self-perceptions of aging and domain-specific health outcomes among midlife and later-life couples

Objectives: This study places the self-perceptions of aging (SPA)-health link in the couple context and examines how changes in one’s own and spouse’s SPA influence multiple health domains and how such associations differ by gender. Methods: Fixed-effects regression models were estimated. Data were drawn from the Health and Retirement Survey ( N = 5972). Results: For both husbands and wives, almost all health domains declined when their own SPA became more negative. The spouse’s SPA were associated with one’s self-rated health, regardless of gender. Gender differences existed in some cross-spousal health effects; while the husband’s SPA were associated with his wife’s depressive symptoms, the wife’s SPA were associated with her husband’s physical disability, functional limitations, and chronic diseases. Discussion: The SPA–health association extends beyond the individual in married persons, demonstrating intertwined health trajectories in older couples. The detrimental effects of ageism might be underestimated if the spillover effects were not considered.

Correlates of stigma for patients with cancer: a systematic review and meta-analysis

OBJECTIVE

The systematic review and meta-analysis was performed to summarize the available evidence and identify the correlates of cancer stigma.

METHODS

PubMed, EMBASE, Web of Science, the Cochrane Library, and PsycINFO were electronically searched to identify eligible studies about correlates of stigma for patients with cancer. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of included studies. A meta-analysis was performed using the statistical program R.

RESULTS

Thirty-one studies involving a total of 7114 patients were included in the systematic review and meta-analysis. The results of the meta-analysis showed that cancer stigma shared positive associations with male gender, symptoms, depression, anxiety, body image loss, self-blame, social constraint, intrusive thoughts, and ambivalence over emotional expression, and negative associations with income, NK cell subsets, QOL, self-esteem, self-efficacy, cancer screening attendance, doctor's empathy, and medical satisfaction. The results of the descriptive analysis indicated that cancer stigma was positively associated with self-perception of aging, anger, internal attributions, stressful life events, self-perceived burden, and sleep dysfunction, while negatively associated with patient-provider communication and sleep quality.

CONCLUSION

Healthcare staff should pay attention to the identified correlates of cancer stigma. The results of our research can inform the design of interventions to reduce stigma and to improve clinical outcomes in people with cancer.

Patient-Level Factors Associated with Oncology Provider-Delivered Brief Tobacco Treatment Among Recently Diagnosed Cancer Patients

Background:

A cancer diagnosis is seen as a “teachable moment” for patients to consider changing their behavioral risk factors, such as smoking. It also offers an opportunity for oncology providers to engage in a dialogue about how they can support patients changing their smoking behaviors. Brief, evidence-based tobacco cessation treatment delivered by oncology providers through the 5As (Ask, Advise, Assess, Assist Arrange) model is recommended, but provision to cancer patients remains suboptimal.

Aim:

Explore patient-level factors associated with 5As receipt among current smokers with a newly diagnosed cancer.

Method:

A total of 303 patients self-reported whether they received each of the 5As during their most recent oncology care visit. Multivariable regression analyses were conducted to identify patient-level factors associated with 5As receipt.

Results:

Oncology provider-delivered 5As rates ranged from 81.5% (Ask) to 30.7% (Arrange). 5As receipt was associated with: reporting lower illness-related stigma, diagnosis of a comorbid smoking-related disease, diagnosis of a smoking-related cancer, and diagnosis of a non-advanced cancer.

Conclusion:

Findings support previous literature in which smoking-related diagnoses were associated with greater receipt of 5As; however, disparities in the receipt of 5As existed for patients with more advanced cancer diagnoses and illness-related stigma. Inequities in the provision of quit assistance may further decrease treatment effectiveness and survival expectancy among certain patient populations. These findings are, therefore, important as they identify specific patient-level factors associated with lower 5As receipt among newly diagnosed cancer patients.

Impact of self-perception of aging on mortality of older patients in oncology

OBJECTIVE

Several studies show that self-perception of aging (SPA) is a significant predictor of mental and physical health. In this study, we analyze the effect of SPA on mortality in the specific context of geriatric oncology.

METHODS

The sample constituted of 140 individuals aged 65 years and older suffering from a recent nonmetastatic cancer (breast, lung, gynecological, or hematological), followed up to 6 years. We used Cox proportional hazards model to assess the effect of SPA at baseline on mortality. It was adjusted for age, gender, educational and cognitive level, oncological information (the site and kind of cancer), number of comorbidities, and physical and mental health at baseline.

RESULTS

Patients were aged 73 years at diagnosis and were more often women (85.7%). Individuals with more negative SPA were 3.62 times more likely to die than those with a more positive SPA, with control of gender, age, education and cognitive level, mental and physical health, the category (breast, lung, gynecological, or hematological), and kind (initial or recurrence) of cancer.

CONCLUSIONS

These findings suggest that SPA influence the mortality of older people in the particular context of oncology. Therefore, the need to change our attitudes toward aging and older people implied indirectly by these results is discussed.

Relationships of self-perceived age with geriatric assessment domains in older adults with cancer

OBJECTIVES

Older self-perceived age is associated with poor health and higher healthcare utilization in the geriatric population. We evaluated the associations of self-perceived age with geriatric assessment (GA) domain impairments in older adults with cancer.

METHODS

This was a secondary analysis of baseline data from a GA cluster-randomized trial (URCC 13070; PI: Mohile). We included patients aged ≥70 with incurable stage III/IV solid tumor or lymphoma considering or receiving treatment and had ≥1 GA domain impairment other than polypharmacy. Multivariate analyses were used to evaluate the associations of age difference between chronological and self-perceived age (categorized into "feeling younger than chronological age" vs. "feeling the same or older than their chronological age") with GA domain impairments.

RESULTS

We included 533 patients; mean age was 76.6 (SD 5.2). On multivariate analyses, compared to those who felt younger than their chronological age, those who felt the same or older were more likely to have impairments in physical performance [Adjusted Odds Ratio (AOR) 5.42, 95% Confidence Interval (CI) 1.69-17.40)], functional status (AOR 2.31, 95% CI 1.73-3.07), comorbidity (AOR 1.62, 95% CI 1.20-2.19), psychological health (AOR 2.62, 95% CI 1.85-3.73), and nutrition (AOR 1.65, 95% CI 1.20-2.28). They were also more likely to screen positively for polypharmacy (AOR 1.86, 95% CI 1.30-2.65).

CONCLUSIONS

Older adults with cancer who felt the same or older than their chronological age were more likely to have GA domain impairments. Further studies are needed to better understand the relationships between self-perceived age, aging-related conditions, and outcomes in this population.

Are Self-perceptions of Aging Associated With Health Trajectories Among Middle-Aged and Older Adults?

Background and Objectives

Older adults’ health trajectory is often pictured as loss and decline. Recent literature has questioned this assumption. Conceptualizing health as a multidimensional construct, encompassing physical disabilities, functional limitations, chronic diseases, depressive symptoms, memory problems, and self-rated health, we investigated patterns of health trajectories among middle-aged and older adults in the United States. Moreover, we investigated the relationship between self-perceptions of aging (SPAs) and health trajectory patterns.

Research Design and Methods

We used latent class growth modeling to examine health trajectory patterns, based on longitudinal data with 4 measurement points over a 7-year period from a national sample of 10,212 middle-aged and older adults (aged 51 and older). Multinomial logit models were used to examine how health trajectory patterns were associated with baseline SPA.

Results

We identified 4 health trajectory patterns: accelerated aging, usual aging, depressed aging, and healthy aging. The full model shows that with each one-unit increase in negative SPA, the odds of belonging to an accelerated aging group, depressed aging group, and usual aging group (vs healthy aging group) increased by 26%, 17%, and 9%, respectively.

Discussion and Implications

The combination of health changes across different domains results in health trajectories that cannot be understood as simply a declining process. SPAs are associated with individuals’ trajectories of health.