Cancer Increases Risk for Other Health Issues Among Older Adults

Older patients with cancer experience greater declines in physical functioning, according to a recent study published in the journal Cancer. Further, these patients also were at an increased risk of depression.

The study, led by Corinne R. Leach from the American Cancer Society, sought to answer a simple question: Does cancer create or worsen health problems in older patients?

The study surveyed 4,605 people without cancer as well as 921 older patients with cancer, excluding those with in situ or stage 4 disease, who were diagnosed with prostate, lung, breast or colorectal cancer, the most common forms of cancer in older adults.

Patients with cancer were initially assessed in 1998 and 2001, then completed a follow-up assessment two years later. To make results as accurate as possible, every patient was matched with five people who did not have cancer from the control group who were similar in their education levels, sex, age, race/ethnicity, marital status, smoking status and preexisting health conditions.

An understanding of the connection between cancer and health problems found in old age may allow physicians to provide patients with an accurate picture of what to expect, as well as preventative measures and exercises to slow down or stop other health problems from occurring.

Participants were evaluated based on health conditions they already had, newly diagnosed health conditions and overall functionality in day-to-day life.

Activities of Daily Living (ADL), in this study, included bathing, dressing, eating, getting in or out of chairs, walking and using the toilet. The most significant changes from the baseline assessment to follow-up were among patients with lung cancer, who reported difficulty with or inability to perform bathing (12 percent at baseline to 22 percent at follow-up), dressing (8 to 19 percent), eating (5 to 14 percent), and getting in and out of chairs (21 to 34 percent). According to the study’s authors, “only the patients with lung cancer reported larger overall declines in sum ADLs compared with the control group.”

Participants were also assessed on the appearance of depression, urinary incontinence, arthritis and sensory impairments. Evidence proved patients with colorectal cancer and prostate cancer are most at risk for experiencing Major Depressive Disorder (MDD). Patients with prostate cancer also suffered more from urinary incontinence, as difficulty maintaining bladder control increased from 23 to 41 percent increase. Other groups experienced little change, with the control group going from 23 to 25 percent, patients with colorectal cancer increasing from 25 to 27 percent, patients with breast cancer changing from 34 to 33 percent and patients with lung cancer increasing from 20 to 23 percent. Although minor changes were noted in the prevalences of arthritis, as well as hearing and sight problems, the changes were not large enough to be considered statistically significant.

Changes in preexisting health conditions, such as arthritis and neuropathy, were also examined, though none of the results portrayed a link between cancer and these issues.

Cancer, ultimately, has the greatest effect on ADLs and has absolutely no correlation with the worsening of medical conditions, such as arthritis or neuropathy. The appearance of health problems, such as depression, urinary incontinence, arthritis and sensory impairments, is due to a combination of cancer and aging.

Although patients with a stage 4 cancer diagnosis were excluded from the study, patients with a diagnosis of stage 3B lung cancer were surveyed, despite the fact that they commonly only receive palliative care. Their inclusion may have affected the results, wrote the study’s authors. Future studies regarding the issue are necessary to evaluate the relationship between cancer and other health conditions in aging, as well as younger patients.

“Decreased physical functioning among older patients with cancer is an important finding for clinicians because it is also actionable,” the authors wrote. “Health care providers need to recommend interventions, such as home-based diet and exercise, for preserving physical function to limit the declines among older patients with cancer. Furthermore, health care providers need to improve the coordination of care so that patients and families are prepared for the changes in functioning levels.”