Impact of a structured multidisciplinary intervention on quality of life of older adults with advanced cancer

Abstract

Background: Patients experience reductions in quality of life (QOL) while receiving cancer treatment and several approaches have been proposed to address QOL issues. In this project, the QOL differences between older adult (age 65+) and younger adult (age 18-64) advanced cancer patients in response to a multidisciplinary intervention designed to improve QOL were examined.

Methods: This study was registered on ClinicalTrials.gov, NCT01360814. Newly diagnosed advanced cancer patients undergoing radiation therapy were randomized to active QOL intervention or control groups. Those in the intervention group received six multidisciplinary 90-minute sessions designed to address the five major domains of QOL. Outcomes measured at baseline and weeks 4, 27, and 52 included QOL (Linear Analogue Self-Assessment (LASA), Functional Assessment of Cancer Therapy-General (FACT-G)) and mood (Profile of Mood States (POMS)). Kruskall-Wallis methodology was used to compare scores between older and younger adult patients randomized to the intervention.

Results: Of 131 patients in the larger randomized controlled study, we report data on 54 evaluable patients (16 older adults and 38 younger adults) randomized to the intervention. Older adult patients reported better overall QOL (LASA 74.4 vs. 62.9, p = 0.040), higher social well-being (FACT-G 91.1 vs. 83.3, p = 0.045), and fewer problems with anger (POMS anger-hostility 95.0 vs. 86.4, p = 0.028). Long-term benefits for older patients were seen in the anger-hostility scale at week 27 (92.2 vs. 84.2, p = 0.027) and week 52 (96.3 vs. 85.9, p = 0.005).

Conclusions: Older adult patients who received a multidisciplinary intervention to improve QOL while undergoing advanced cancer treatments benefited differently in some QOL domains, compared to younger adult patients. Future studies can provide further insight on how to tailor QOL interventions for these age groups.

Figure 1

QOL differences between older adult (N=16) and younger adult (N=38) intervention groups over time The mean overall QOL LASA score measuring overall QOL was significantly higher for older adult patients than younger adult patients at week 4 of the intervention (74.4 vs 62.9, p=0.04). *Week 4 overall LASA statistically significant

Figure 2

Mean overall and Social well-being FACT-G score between older adult (N=16) and younger adult (N=38) intervention groups over time The mean FACT-G total score for older adult and younger adult patients stayed relatively stable with no significant differences between these two groups throughout the intervention, but older adult patients had a significantly higher Social well-being score at week 4 of the intervention (91.1 vs 83.3, p=0.045). *Week 4 FACT-G Social well-being score statistically significant

Figure 3

Mood states differences between older adult (N=16) vs. younger adult (N=38) intervention groups over time Older adult patients had significantly lower Anger-Hostility POMS scores at all weeks except baselne, even though the overall POMS score for older adult and younger adult patients did not differ significantly. *Weeks 4, 27, and 52 POMS Anger-Hostility scores statistically significant