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KLIMOP: a cohort study on the wellbeing of older cancer patients Laura Deckx Liesbeth Daniels, Katherine Nelissen, Piet Stinissen, Paul Bulens, Loes Linsen,

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Presentation on theme: "KLIMOP: a cohort study on the wellbeing of older cancer patients Laura Deckx Liesbeth Daniels, Katherine Nelissen, Piet Stinissen, Paul Bulens, Loes Linsen,"— Presentation transcript:

1 KLIMOP: a cohort study on the wellbeing of older cancer patients Laura Deckx Liesbeth Daniels, Katherine Nelissen, Piet Stinissen, Paul Bulens, Loes Linsen, Jean-Luc Rummens, Doris van Abbema, Franchette van den Berkmortel, Hans Wildiers, Vivianne C. Tjan-Heijnen, Marjan van den Akker, Frank Buntinx

2 Klimop Klimop was conceptualised by Prof. Buntinx and Dr. Bulens after a study performed by LIKAS in 2007 among stakeholders “Cancer in Limburg: Challenges and strategic options for a coordinated approach “ This study showed that the challenges in cancer care will be: – The psychosocial aspects of cancer care – Scientific research for older cancer patients

3 Survival: quantity or quality? Survival: quantity – Survival of cancer patients increases – Not for older cancer patients: EUROCARE project (Quaglia 2009) Survival: quality – The fear to loose autonomy > the fear to die (Jolly 2006) – Macmillan Listening Study: To study the impact of cancer on everyday life was defined as the top priority area for cancer research (Okamoto 2011)

4 Klimop-study To assess the impact of cancer, ageing and their interaction on subsequent wellbeing of older cancer patients Comorbidity Functional status DepressionQuality of life

5 Inclusion (January 2011) Baseline6 months1 year... Younger cancer patients Older cancer patients Older patients without cancer Total interviewed Lost to follow-up/404 Deceased/143

6 ComorbidityFunctional statusDepressionQuality of life

7 Comorbidity Comorbidity: the co-occurence of different diseases Comorbidity is an enormous problem (Marengoni 2011) – Highly prevalent (55% - 98%) – Cause of disability, functional impairment, low Qol, high health care costs – Survival

8 Comorbidity Guidelines to for the treatment of cancer patients with comorbidity are lacking! (Signaleringscommissie Kanker van KWF Kankerbestrijding 2011)

9 ComorbidityFunctional statusDepressionQuality of life

10 Functional status Maintenance of independence is very important Associated with survival Cancer patients have more functional problems (Hewitt 2003, Keating 2005) Little prospective studies that investigate the risk factors for functional decline in older cancer patients → Cave! Selection of participants

11 Functional status* : Baseline ~ 6 months WorseIdemBetter BaselineN (%) Younger cancer patients Impaired16 (10%)39 (46%)37 (44%)8 (10%) Not impaired152 (90%) Older cancer patients Impaired23 (23%)12 (27%)21 (48%)11 (25%) Not impaired77 (77%) Older patients without cancer Impaired45 (19%)17 (20%)53 (63%)14 (17%) Not impaired112 (71%) *Functional status (ADL en IADL): Computed as described by Kellen et al. 2010

12 Baseline Functional status* ~ Loneliness Impaired Not impaired NNOR 95% CI Younger cancer patients Lonely27 (18%) – 7.8 Not lonely124 (82%)9115 Older cancer patients Lonely26 (35%) – 14.0 Not lonely48 (65%)642 Older patients without cancer Lonely56 (38%) – 2.5 Not lonely91 (62%)2467 *Functional status (ADL en IADL): Computed as described by Kellen et al. 2010

13 ComorbidityFunctional statusDepressionQuality of life

14 Depression Depression is important: – Leading cause of disability worldwide – Commonly coexists – Predicts overall survival (Kanesvaran 2011 JCO) Depression decreased – overall survival increased! (Giese-Davis 2011 JCO) Results are inconclusive

15 Depression: Baseline ~ 6 months Worse ( >10%) Idem Better (>10%) BaselineN (%) Younger cancer patients Depressive feelings12 (8%)11 (15%)44 (59%)20 (27%) No depressive feelings139 (92%) Older cancer patients Depressive feelings11 (14%)5 (18%)18 (64%)5 (18%) No depressive feelings66 (86%) Older patients without cancer Depressive feelings18 (12%)8 (11%)51 (71%)13 (18%) No depressive feelings133 (88%)

16 Baseline Depression ~ Loneliness GDS-15 ≥ 5 GDS-15 < 5 NNOR 95% CI Younger cancer patients Lonely25 (17%) – 17.1 Not lonely120 (83%)6114 Older cancer patients Lonely 25 (35%) – 45.2 Not lonely46 (65%)244 Older patients without cancer Lonely55 (38%) – 36.4 Not lonely90 (62%)387

17 ComorbidityFunctional statusDepressionQuality of life

18 What is the impact of cancer, cancer treatment, ageing and their interaction on Qol? – Results are inconclusive Methodological shortcomings (Joly 2007) – Cross-sectional – Presentation of mean values! – Prospective but Qol measured only once – Selection of patients

19 Global Qol: Baseline ~ 6 months Worse ( >10%) Idem Better (>10%) N (%) Younger cancer patients Global Qol31 (38%)15 (19%)35 (43%) Older cancer patients Global Qol18 (55%)8 (24%)7 (21%) Older patients without cancer Global Qol17 (21%)35(43%)30 (37%)

20 ComorbidityFunctional statusDepressionQuality of life

21 Wellbeing Little is known about the interaction between the co-occurrence of -Comorbidity -Functional impairment -Geriatric syndromes (Koroukian 2011 JCO) Comorbidity Functional status Depression Quality of life

22 Preliminary conclusions Results are preliminary and cross-sectional! The longer the duration of the study, the more valuable the results will be Loneliness and depression are frequent and important factors that can be influenced Guidelines for care of cancer patients with multimorbidity are needed, taking into account: – Co-morbidity/functional impairment/… – Consequences of cancer treatment – Collaboration between different disciplines in primary and secondary care

23 Take home message Be critical! – Was the study population appropriate? – Cross-sectional design versus prospective design? Older cancer patients – Heterogeneous group – Specific health care needs Quality rather than quantity of survival – Which factors determine maintenance or decline of wellbeing? “Knowing is not enough; we must apply. Willing is not enough; we must do.” Goethe

24 Deckx L, Van Abbema D, Nelissen K, Daniels L, Stinissen P, Bulens P, Linsen L, Rummens JL, Van den Berkmortel F, Robaeys G, De Jonge E, Houben B, Pat K, Walgraeve D, Spaas L, Verheezen J, Verniest T, Goegebuer A, Wildiers H, Tjan-Heijnen V, Buntinx F, Van den Akker M. Study protocol of KLIMOP: a cohort study on the wellbeing of older cancer patients in Belgium and the Netherlands. BMC Publ Health 2011; 11: 825 Contact: KLIMOP is funded by VLK, the Flemisch League against Cancer and Interreg IV cross-border region Flanders – the Netherlands


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