ASPO Abstracts
Differences in Breast and Prostate Cancer Treatment by Cognitive Status in the US Health and Retirement Study
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2022
Abstract Body:
Purpose: The influence of cognitive impairment on the quality of cancer care is largely unknown. We evaluated the association of pre-diagnosis cognitive status with receipt of cancer treatment for incident breast and prostate cancer in the US Health and Retirement Study (HRS) linked to Medicare claims (2000-2016).Methods: Medicare-eligible HRS participants aged ‚â•65 whose first and only cancer was breast or prostate, and who had ‚â•1 year of data before and after diagnosis were included (N=2089). Cancer cases were identified in Medicare using the Chronic Conditions Warehouse cancer algorithm. To capture incident cases, we excluded women who did not have breast cancer surgery. Cognitive status, defined as normal, cognitive impairment no dementia (CIND), or dementia, was assessed at the HRS interview prior to cancer diagnosis using the Langa-Weir method. We assessed the receipt of cancer treatments ((surgery, radiation, chemotherapy, and active surveillance (for prostate cancer only)) in Medicare claims. The association between cognitive status and treatment was estimated using multivariable logistic regression adjusting for race, marital status, year, age, activities of daily living, instrumental activities of daily living, education, and comorbid conditions. Results: In this sample of 334 women with breast cancer and 1,210 men with prostate cancer, 21% of participants had CIND and 7% had dementia prior to their cancer diagnosis. More women with normal cognition received radiation (49%) compared to women with CIND (32%), and dementia (11%) (p<0.05). More men with normal cognition received radiation (7.1%), compared to men with CIND (3.8%) and men with dementia (1.1%) (p=0.02), and more men with normal cognition (19%) were on active surveillance compared to men with CIND (12%) and men with dementia (11%) (p=0.01). Women with dementia had 80% lower odds of receiving radiation compared to women with normal cognition (adjusted OR 0.17 CI 0.03, 0.87). Conclusions: These findings suggest that in this representative sample of older adults, many had cognitive impairment prior to their cancer diagnosis, which may have influenced their cancer treatment. More research is warranted to elucidate the influence of cognitive impairment on cancer treatment decision making.
Keywords: cognitive status, breast cancer, prostate cancer, aging