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. 2021 Jun;12(5):765-770.
doi: 10.1016/j.jgo.2021.02.007. Epub 2021 Feb 18.

Prevalence of functional limitations and their associations with systemic cancer therapy among older adults in nursing homes with advanced non-small cell lung cancer

Orestis A Panagiotou  1 , Tamra Keeney  2 , Jessica A Ogarek  3 , Elizabeth Wulff-Burchfield  4 , Adam J Olszewski  5 , Emmanuelle Bélanger  6
Affiliations

Prevalence of functional limitations and their associations with systemic cancer therapy among older adults in nursing homes with advanced non-small cell lung cancer

Orestis A Panagiotou et al. J Geriatr Oncol. 2021 Jun.

Abstract

Objectives: To determine the relationship of self-care task disabilities with the use of systemic cancer therapies for advanced non-small cell lung cancer (NSCLC) in nursing home patients.

Materials and methods: Using the Surveillance, Epidemiology, and End Results-Medicare database linked with Minimum Data Set assessments, we identified nursing home residents with advanced NSCLC from 2011 to 2015. We considered disability in activities of daily living (ADL) including dressing, personal hygiene, toilet use, locomotion on unit, transfer, bed mobility, and eating. We estimated the association between ADL disabilities and receipt of systemic cancer therapies within 3 months of diagnosis.

Results: Of the 3174 patients, 2702 (85.2%) experienced disability in one or more ADLs and 64.7% had disability in 5-7 ADLs. A total of 415 (13.1%) patients received systemic therapy. There was a strong association between disability in each ADL and receipt of therapy including dressing (OR, 0.52 [95% CI, 0.42-0.65]), toileting (odds ratio, OR, 0.52 [95% confidence interval, CI, 0.42-0.65]), personal hygiene (OR, 0.48 [95% CI, 0.39-0.59]), transfers (OR, 0.51 [95% CI, 0.41-0.64]), bed mobility (OR, 0.55 [95% CI, 0.44-0.69]), locomotion (OR, 0.57 [95% CI, 0.46-0.71]), or eating (OR, 0.45 [95% CI, 0.31-0.67]). Compared to patients having no ADL disability, patients were less likely to receive chemotherapy if they had disability in 1-2 ADLs (OR, 0.95 [95% CI, 0.66-1.37]), 3-4 ADLs (OR, 0.81 [95% CI, 0.56-1.15]), or 5-7 ADLs (OR, 0.43 [95% CI, 0.33-0.56]).

Conclusions: Systemic cancer therapy is not commonly used in this population and is strongly predicted by disability in self-care tasks.

Keywords: Functional status; Lung cancer; Nursing homes.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES

Dr. Panagiotou reports receiving personal fees from International Consulting Associates, Inc. outside the submitted work. Dr. Olszewski reports receiving research funding from Adaptive Biotechnologies, Genentech, Spectrum Pharmaceuticals, and TG Therapeutics. Dr. Wulff-Burchfield has served in a consultative or advisory role for Astellas and Exelixis and has a family member with stock ownership in Immunomedics and Nektar, all of which is outside the submitted work. No other disclosures are reported.

Figures

Figure 1.
Figure 1.
Flow Diagram of Cohort Selection
Figure 2.
Figure 2.. Associations between Disability in Activity of Daily Living Tasks and Receipt of Systemic Cancer Therapy
Adjusted models included the following covariates: age at diagnosis, sex, race/ethnicity, whether the patient was a long-stay nursing home resident, presence of pain, depressive symptoms, cognitive function, receipt of radiation therapy, and comorbidity index. ADL: activity of daily living; CI: confidence interval; OR: odds ratio
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