Date Presented 4/17/2015
Older adults are at risk of functional decline after a diagnosis of cancer, yet little is known about the association of those deficits and the subsequent use of cancer rehabilitation. This study provides the needed evidence to move toward the increased use of our services for this population.
SIGNIFICANCE: Older adults are at risk of suffering adverse consequences of cancer and its associated treatments. Occupational and physical therapy services seek to reduce morbidity and mortality and to improve the quality of life of individuals; however, little is known about the needs of this population and their subsequent use of cancer rehabilitation.
INNOVATION: Typically, research has examined either the use of occupational/physical therapy in general or the retrospective and perceived need for services in survey form. This study was able to examine the actual need for therapy and the use of such services by linking a large registry with information from a geriatric assessment that includes variables of functional status, falls, balance, social limitations, and cognition of older adults with cancer with billing claims data for analysis of appropriate utilization.
METHOD: This study is a retrospective, secondary data analysis of linked cross-sectional data. Older adults (65+ yr) with a diagnosis of cancer were recruited within an outpatient oncology appointment. The aims of this study include the following: (1) to describe the functional deficits of a sample of older adults with cancer as defined by a geriatric assessment, (2) to examine the associations of functional deficit in this population, and (3) to examine the appropriate use of cancer rehabilitation services after noted functional deficit. Adults completed a geriatric assessment for the registry, and their clinicians were blind to results. Variables included cancer type and status, functional status (defined by physical health, instrumental activities of daily living [IADL], cognition, falls, timed up and go [TUG], and social limitations), social support, demographics, and billing codes for occupational and physical therapy. Logistic regression was used to model associations of functional status. Descriptive statistics were used to describe therapy use.
RESULTS: A total of 529 patients with cancer (median age = 71 yr) participated. Of the participants, 78% were female, 87% were Caucasian, 57% were married, 53% had completed postsecondary education, and 63% had breast cancer. In a multivariable model, the odds of having any deficits increased with age (5-yr odds ratio [OR] = 1.31, 95% confidence interval [CI] [1.10, 1.57]), were higher for those with a high school diploma versus those with advanced degrees (OR = 1.66, 95% CI [1.00, 2.77]), and were higher for patients with comorbidities (OR = 1.15, 95% CI [1.10, 1.21]). Of patients with functional deficits, 1% to 6% (20/341) received cancer rehabilitation between 3 and 12 mo of noted deficit.
