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Comorbidity, Disability, and Geriatric Syndromes in Elderly Cancer Patients Receiving Home Health Care

Siran M. Koroukian, Patrick Murray, Elizabeth Madigan

From the Division of Health Policy, Department of Epidemiology and Biostatistics, School of Medicine, and Frances P. Bolton School of Nursing, Case Western Reserve University, and the Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, OH

Address reprint requests to Siran M. Koroukian, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106-4945; e-mail: skoroukian{at}case.edu

PURPOSE: To assess the prevalence of comorbidity, disability, and geriatric syndromes, or a combination thereof, in elders with cancer receiving home health care (HHC).

PATIENTS AND METHODS: Using the Ohio Cancer Incidence Surveillance System, we identified Ohio residents 65 years of age or older who were diagnosed with incident breast (n = 952), prostate (n = 324), or colorectal cancer (n = 1,276) during the 28-month study period, August 1999 through November 2001. We used the Outcome and Assessment Information Set, a database compiling comprehensive assessment forms completed for all HHC patients, to group individuals in independent and overlapping categories of comorbidity, disability, and geriatric syndromes on the basis of the patients' clinical condition 14 days before the date of the assessment.

RESULTS: The proportion with no comorbidity, disability, or geriatric syndromes was 26.4% in breast cancer patients, 12.0% in prostate cancer patients, and 14.0% in colorectal cancer patients. The proportion of patients presenting all three entities at once was 11.7%, 24.7%, and 15.7%, respectively, in three cancer sites. As expected, the proportion of patients with no comorbidity, disability, or geriatric syndromes declined gradually with increasing age, and that of patients with all three entities was highest among patients 85 years or older.

CONCLUSION: The proposed taxonomy will help us gain a more nuanced understanding of older cancer patients' clinical presentation and may lead to a more accurate identification of older patients who might benefit from standard cancer treatment, and those who might experience adverse outcomes.

Supported by a National Institutes of Health Cancer-Aging Research Development Grant (P20 CA103736; S.M.K., pilot project investigator); and by a Career Development Grant from the National Cancer Institute (K07 CA096705 to S.M.K.).

Presented in part at the 3rd Annual Meeting of the Geriatric Oncology Consortium, Washington, DC, September 15-17, 2005.

Cancer incidence data were obtained from the Ohio Cancer Incidence Surveillance System (OCISS), Ohio Department of Health. Use of these data does not imply that the Ohio Department of Health either agrees or disagrees with any presentation, analyses, interpretations, or conclusions. Information about the OCISS may be obtained at odh.state.oh.us/ODHPrograms/CI_SURV/ci_surv1.htm.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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