ASPO Abstracts
A retrospective study of administrative data to identify factors associated with future disability status among older colorectal cancer survivors
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2020
Abstract Body:
Disability is associated with loss of independence and early mortality. Currently, only 1-2% of cancer survivors who reported physical limitations received rehabilitation services. It is critical to identify factors associated with the development of disability to guide clinical practice given treatment changes. We aimed to 1) identify demographic and cancer-related characteristics associated with future disability status among older colorectal cancer survivors, and 2) compared the future disability status among cancer and matched non-cancer cohorts.
Methods: We conducted a retrospective cohort study using the Texas Cancer Registry-national Medicare linked database. The cancer cohort included Medicare beneficiaries with a primary colorectal cancer diagnosis between 2005 and 2013 (n=13,229). The non-cancer cohort was identified from a 5% sample of Medicare beneficiaries (n=11,416). Diagnosis dates from the cancer cohort were used as the index date for the non-cancer cohort. Cohorts were matched 1:1 based on index date, age, and gender. Cox regression models were used to estimate
hazard ratios (HRs) and 95% confidence intervals. Disability status was defined according to Davidoff et al. using inpatient, outpatient and durable medical equipment claims files, and assessed monthly, beginning 1 month after cancer diagnosis (or index date), continuing until disability, death, end of Medicare continuous enrollment, or end of study.
Results: Factors that were significantly associated with disability status in the cancer cohort were age (HR=3.50 for >80 years old), female gender (HR=1.50), race/ethnicity (HR=1.34 for Hispanic and 1.21 for Black), stage (HR=2.26 for distant stage), comorbidity (HR=2.18 for >1), and radiation (HR=1.21). When compared to the non-cancer cohort, having a cancer diagnosis (HR=1.07) and comorbidity (HR=2.09 for >1) were associated with developing disability.
Conclusions: Colorectal diagnosis is an independent risk for disability status. Beyond well-known risk factors "age and mortality" subsets of survivors (Hispanic and Black survivors and those with comorbidity) are found to be at higher risk for developing disability. This warrants further investigation and may indicate targeted intervention to prevent future disability.
Keywords: Survivorship; Disability; Administrative data