Effects of cancer history and comorbid conditions on mortality and healthcare use among older cancer survivors

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Abstract
BACKGROUND Older cancer survivors use healthcare services to an increased extent relative to their counterparts who have no history of malignant disease. In the current study, the authors set out to assess the effects of cancer history and comorbid conditions on healthcare use and mortality. METHODS Using information from the 1992 North Carolina Established Populations for Epidemiologic Study of the Elderly database, study participants were classified as having no history of malignant disease or as having a recent (cancer diagnosed < 1 year earlier), intermediate (cancer diagnosed 1–6 years earlier), or remote (cancer diagnosed > 6 years earlier) history of malignancy. Overall, 15 different comorbid conditions were ascertained. Logistic regression models adjusted for sociodemographic factors, tobacco and alcohol use, and functional measures were used to determine the risk of emergency room, hospital, and nursing home (NH) admission in 1992 and also in 1996 according to history of malignancy and presence of comorbid conditions. Using data from the National Death Registry, a similar controlled analysis of 7‐year mortality also was performed. RESULTS There were 2567 participants in the current study (mean age, 79 years; range, 71–102 years); 69% of all participants were women, 55% were African American, and 14% reported having a history of malignancy. Participants with a history of malignancy had an average of 3 comorbid conditions, and differences across groups in terms of cardiovascular and lung disease incidence were noted. Controlled analyses revealed that recent cancer history (odds ratio [OR], 15.5; 95% confidence interval [CI], 7.0–34.2) and intermediate cancer history (OR, 2.1; 95% CI, 1.4–3.3) were associated with same‐year hospital admission. In addition, having a recent history of malignancy in 1992 was found to be correlated with NH admission 4 years later (OR, 3.1; 95% CI, 1.1–9.1). History of malignancy was not associated with mortality. CONCLUSIONS Cancer history had limited influence on healthcare use and mortality. Efforts aimed at improving health‐related outcomes in older cancer survivors should continue to focus on attenuating the impact of comorbid conditions. Cancer 2004. Published 2004 by the American Cancer Society.