Function, cognition, and quality of life among older adults with lung cancer who live alone: A prospective cohort study

Surbhi Singhal¹, Louise C Walter², Alexander K Smith², W John Boscardin², Ying Shi², Harvey Jay Cohen³, Carolyn J Presley⁴, Lawrence H Kushi⁵, Smith Giri⁶, Allison Magnuson⁷, Grant R Williams⁶, Ana I Velazquez⁸, Howard J Lee Jr⁹, Lori C Sakoda⁵, Charles P Quesenberry⁵, Jason R Falvey¹⁰, Kathleen M Van Dyk¹¹, Melisa L Wong¹²

Affiliations

¹ Division of Hematology/Oncology, Department of Medicine, University of California, Davis, Sacramento, CA, USA.
² Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
³ Center for the Study of Aging & Human Development and Duke Cancer Institute, Duke University, Durham, NC, USA.
⁴ Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
⁵ Division of Research, Kaiser Permanente Northern California, The Permanente Medical Group, Oakland, CA, USA.
⁶ Divisions of Hematology/Oncology and Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, AL, USA.
⁷ James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
⁸ Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA.
⁹ Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
¹⁰ Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, USA.
¹¹ Division of Geriatric Psychiatry, Department of Psychiatry, University of California, Los Angeles Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
¹² Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Division of Research, Kaiser Permanente Northern California, The Permanente Medical Group, Oakland, CA, USA. Electronic address: melisa.wong@kp.org.

PMID: 39288505
PMCID: PMC12312441
DOI: 10.1016/j.jgo.2024.102068

Function, cognition, and quality of life among older adults with lung cancer who live alone: A prospective cohort study

Surbhi Singhal et al. J Geriatr Oncol. 2024 Nov.

. 2024 Nov;15(8):102068.

doi: 10.1016/j.jgo.2024.102068. Epub 2024 Sep 16.

Authors

Affiliations

¹ Division of Hematology/Oncology, Department of Medicine, University of California, Davis, Sacramento, CA, USA.
² Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
³ Center for the Study of Aging & Human Development and Duke Cancer Institute, Duke University, Durham, NC, USA.
⁴ Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
⁵ Division of Research, Kaiser Permanente Northern California, The Permanente Medical Group, Oakland, CA, USA.
⁶ Divisions of Hematology/Oncology and Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, AL, USA.
⁷ James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
⁸ Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA.
⁹ Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
¹⁰ Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, USA.
¹¹ Division of Geriatric Psychiatry, Department of Psychiatry, University of California, Los Angeles Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
¹² Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Division of Research, Kaiser Permanente Northern California, The Permanente Medical Group, Oakland, CA, USA. Electronic address: melisa.wong@kp.org.

PMID: 39288505
PMCID: PMC12312441
DOI: 10.1016/j.jgo.2024.102068

Abstract

Introduction: Among older adults without cancer, living alone is associated with poor health outcomes. However, among older adults with non-small cell lung cancer (NSCLC) who live alone, data on function, cognition, and quality of life (QOL) during systemic treatment remain limited.

Materials and methods: We enrolled adults aged ≥65 with advanced NSCLC starting a new chemotherapy, immunotherapy, and/or targeted therapy regimen with non-curative intent. Patients completed geriatric assessments including instrumental activities of daily living (IADL), Montreal Cognitive Assessment, and QOL pretreatment and at 1, 2, 4, and 6 months, or until treatment discontinuation, whichever occurred earlier. We categorized change in IADL, cognition, and QOL as stable/improved, declined with recovery, or declined without recovery using clinically meaningful definitions of change. We used multinomial logistic regression to compare change between patients who lived alone versus with others.

Results: Among 149 patients, median age was 73; 21% lived alone. Pretreatment IADL, cognition, and QOL scores were similar between older adults who lived alone versus with others. During NSCLC treatment, older adults who lived alone had similar trajectories of function (52% functional decline vs 38%), cognition (43% cognitive decline vs 50%), and QOL (45% QOL decline vs 44%) compared with those who lived with others. In unadjusted analyses, patients who lived alone were more likely to develop functional decline with recovery (reference category: stable/improved function) than those who lived with others (relative risk ratio 4.07, 95% CI 1.14-14.6, p = 0.03). However, this association was not observed after adjusting for age, race, prior NSCLC treatment, current treatment group, and pretreatment geriatric assessment differences. There were no differences in cognitive or QOL trajectories in unadjusted or adjusted analyses.

Discussion: Approximately half of older adults with advanced NSCLC who lived alone were able to maintain their function, cognition, and QOL during NSCLC treatment, which was similar to older adults who lived with others. Many older adults with advanced NSCLC who live alone can receive systemic treatment with individualized supportive care.

Keywords: Cognition; Function; Instrumental activities of daily living; Lung cancer; Older adults; Quality of life.

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Conflict of interest statement

Declaration of Competing Interest SS reported conflicts of interest outside the submitted work (consultant/advisory to Oncohost). AIV reported conflicts of interest outside the submitted work (consultant/advisory to Merus and AstraZeneca). LCS has received research funding from AstraZeneca awarded directly to her institution. MLW reported conflicts of interest outside of the submitted work (royalties from UpToDate; immediate family member is an employee of Genentech with stock ownership). The remaining authors have no conflicts to report.

Figures

**Figure 1.. Sankey diagram for change in function among older adults with advanced non-small cell lung cancer who (A) lived alone versus (B) lived with others during systemic therapy (n=121).**
Functional decline was defined as a clinically meaningful decline in instrumental activities of daily living (≥1-point decrease) at any follow-up assessment.

**Figure 2.. Sankey diagram for change in cognition among older adults with advanced non-small cell lung cancer who (A) lived alone versus (B) lived with others during systemic therapy (n=128).**
Cognitive decline was defined as a clinically meaningful decline in Montreal Cognitive Assessment (≥1.73-point decrease) at any follow-up assessment.

**Figure 3.. Sankey diagram for change in quality of life among older adults with advanced non-small cell lung cancer who (A) lived alone versus (B) lived with others during systemic therapy (n=114).**
Quality of life decline was defined as a clinically meaningful decline in EORTC QLQ-C30 global health/quality of life subscore (≥10-point decrease) at any follow-up assessment. EORTC QLQ-C30: European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire

See this image and copyright information in PMC

References

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Function, cognition, and quality of life among older adults with lung cancer who live alone: A prospective cohort study

Affiliations

Function, cognition, and quality of life among older adults with lung cancer who live alone: A prospective cohort study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical