Addressing HRQOL to Improve Outcomes in Older Cancer Patients

Maintaining physical functioning, addressing appetite loss, and alleviating constipation are the most relevant components of health-related quality of life (HRQOL) for older cancer patients to achieve optimal care. These findings were published in the European Journal of Cancer (doi:10.1016/j.ejca.2015.08.027).

"Our study shows that HRQOL is impaired in cancer patients compared to the general population, but that the impact on specific HRQOL domains varies by age,” said senior investigator Andrew Bottomley, MD, Head of the Quality of Life Department of the European Organisation for Research and Treatment of Cancer (EORTC). “Within the cancer population, some HRQOL components improve with age while others deteriorate. Optimal care for older cancer patients should target HRQOL domains most relevant to this population."

Indeed, HRQOL of cancer patients varies with age. Young cancer patients typically experience worse financial problems as well as social and role functioning while older cancer patients experience more appetite loss.

Within the cancer cohort in this EORTC study, it was found that HRQOL was worse with increasing age for physical functioning and constipation, and better with increasing age for social functioning, insomnia, and financial problems. Though the HRQOL burden changed with age for each cancer site, the magnitude and size differed between cancer sites.

"It was a huge benefit for us to be able to pool data from 25 closed EORTC trials and make the most of the data we had collected from over 6000 patients,” said lead author Chantal Quinten, MSc, formerly of the EORTC and now at the European Centre for Disease Prevention and Control, Surveillance and Response Support, Epidemiological Methods Unit in Stockholm, Sweden.  “Not only were we able to analyze and report on the primary trial results, but we were also able to perform additional analyses and, thereby, further increase our understanding using data we already had on file. This is a very efficient approach to clinical research."

The EORTC researchers point out that it is essential for healthcare professionals to understand how the disease and its treatments can affect HRQOL in order to improve the care of cancer patients. Clinicians can incorporate HRQOL in shared decision making to enhance patient management. The incidence of cancer is higher in the elderly, and as the general population continues to age, ensuring that elderly patients with cancer receive appropriate care will be of increasing importance.

Many questionnaires that assess HRQOL exist, and the EORTC QLQ-C30 is one of the most widely used with its 30-item Quality of Life Questionnaire Core module. General population values for the EORTC QLQ-C30 provide a useful reference for interpreting the impact of cancer and its treatment.

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