PARIS – For elderly nursing home residents, a cancer diagnosis often comes at an advanced stage and fails to trigger appropriate therapy or overall general care, according to data from a study of more than 145,000 nursing home residents in the United States.
Even early-stage cancers are likely to go untreated, and more than 20% of patients in pain receive no medication, regardless of the cancer site or the degree of pain, investigators reported at the annual meeting of the International Society for Geriatric Oncology.
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The study evaluated data on 145,757 elderly people who were recently admitted to nursing homes.
"We saw that late and unstaged cancer was more prevalent in nursing home patients than in other elderly patients," Dr. Giuseppe Colloca, a geriatrician at the Università Cattolica del Sacro Cuore in Rome, told attendees.
"Older age was associated with late-stage diagnosis and death within a few months of diagnosis," Dr. Colloca said, adding that there was "low hospice use and very little cancer-directed treatment – even among patients with early-stage cancer."
The aim of the study was to look at patterns of cancer diagnosis, survival, treatment, and quality of care among elderly individuals recently admitted to nursing homes. In the United States, an estimated 5% of elderly individuals live in nursing homes categorized as offering a high-level of care, with a further 1.5% in residential care that provides lower levels of nursing support, according to Dr. Colloca.
The investigators obtained data on individuals aged 65 years or older whose records were contained with the SAGE (Systematic Assessment of Geriatric Drug Use via Epidemiology) database. This is a multilinked database of clinical care information based on a census of all nursing home residents in the United States.
The study evaluated data on 145,757 elderly individuals who were recently admitted to a nursing home in five U.S. states; of these, 21,064 (14%) had a cancer diagnosis that was made in most cases after admission. Among these residents with cancer, the most common diagnoses were prostate (10.8%) and lung (9%) tumors, with other known cancer types including colon (6.7%), breast (4.5%), bladder (3.1%), anal (2.9%), skin (2.2%), brain (1.6%), pancreas (1.5%), and renal (1.5%).
Analysis of sociodemographic characteristics showed that across all tumor types, the average age was between 75 and 84 years of age but did vary according to the type of tumor. More than 40% of patients with prostate or colon cancer were 85 years or older, while just 13% of lung cancer patients were this old.
Most of the elderly cancer patients were white (83.2%-91.2%), with moderate (49.7%-54.4%) or severe (34.9%-44.1%) limitations in physical function. More than half were moderately (36.4%-44.1%) or severely (7.8%-11.3%) cognitively impaired.
Around a quarter of patients experienced daily symptoms of pain, with other common symptoms including shortness of breath, constipation, unstable cognitive status, edema, and recent falls. "Control of pain symptoms has been shown to be inadequate among nursing home cancer patients," Dr. Colloca said.
Dr. Giuseppe Colloca
"Chemotherapy and radiation treatment were really quite infrequent," he added, noting that while 17.1% of breast cancer patients received chemotherapy, only 2.9% of those with colon cancer received such treatment. Chemotherapy rates also were low among those with lung (3%), prostate (6.3%), and "other" (5.4%) tumors.
Lung cancer patients were more likely to receive radiation with a radiotherapy rate of 10.9%. In the other cancer patients radiotherapy rates ranged from 0.9% for colon cancer to 4.2% for "other." Only 3.8% of breast tumors and 2.9% of prostate cancers were treated with radiation.
A terminal diagnosis of cancer was reported in 8.4% of breast, 8.9% of prostate, 10.5% of colon, 12.4% of "other," and 21.5% of lung tumors. Lung cancer patients also had the highest 1-year mortality rate: 91.9% (lung). But 1-year mortality was high across the board at 80% in breast cancer patients, 78.6% (prostate), 80.9% (colon), and 83.2% ("other’).
Survival time was usually short, at just 54 days for those with lung cancer and 110 days for patients with "other" cancers. The longest survival times were in breast (172 days), prostate (149 days), and colon (142) cancers.
"Cancer appears to be ignored in the nursing home," Dr. Colloca observed in an interview. "Often there is a misdiagnosis of cancer," with patients not being diagnosed with terminal cancer and cancer considered more of a comorbidity." This needs to be addressed, he said.
Dr. Colloca reported no conflicts of interest. The society is also known as the Société Internationale d’Oncologie Gériatrique (SIOG).