Impact of age, comorbidity, and polypharmacy on receipt of systemic therapy in advanced cancers: A retrospective population-based study

Rebekah Rittberg; Kathleen Decker; Pascal Lambert; Jen Bravo; Philip St John; Donna Turner; Piotr Czaykowski; David E Dawe

doi:10.1016/j.jgo.2023.101689

Impact of age, comorbidity, and polypharmacy on receipt of systemic therapy in advanced cancers: A retrospective population-based study

J Geriatr Oncol. 2024 Mar;15(2):101689. doi: 10.1016/j.jgo.2023.101689. Epub 2024 Jan 13.

Authors

Rebekah Rittberg¹, Kathleen Decker², Pascal Lambert³, Jen Bravo³, Philip St John⁴, Donna Turner², Piotr Czaykowski⁵, David E Dawe⁶

Affiliations

¹ Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; Department of Medical Oncology, BC Cancer, Vancouver, Canada.
² CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Canada.
³ Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Canada.
⁴ Section of Geriatric Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; Centre on Aging, University of Manitoba, Winnipeg, Canada.
⁵ Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada.
⁶ Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Canada; Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada. Electronic address: ddawe@cancercare.mb.ca.

PMID: 38219331
DOI: 10.1016/j.jgo.2023.101689

Abstract

Introduction: Cancer incidence, comorbidity, and polypharmacy increase with age, but the interplay between these factors on receipt of systemic therapy (ST) in advanced cancer has rarely been studied.

Materials and methods: A retrospective cohort study was conducted including patients aged ≥18 years diagnosed from 2004 to 2015 with multiple myeloma (MM) (all stages), lung cancer (stage IV), and stage III-IV non-Hodgkin's lymphoma (NHL), breast, colorectal (CRC), prostate, or ovarian cancer in Manitoba, Canada. Clinical and administrative health data were used to determine demographic and cancer characteristics, treatment history, comorbidity (Charlson Comorbidity Index [CCI] and Resource Utilization Band [RUB]), and polypharmacy (≥6 medications). Multivariable logistic regression was used to evaluate variable associations with receipt of ST and interaction with age.

Results: In total, 17,228 patients were diagnosed with advanced cancer. Ages were distributed as follows: 7% <50 years, 16% 50-59 years, 26% 60-69, 26% 70-79, 24% ≥80 years. ST was administered to 50% of patients. Increased age, polypharmacy, and comorbidity each independently decreased the likelihood of receiving ST. Significant interaction effects were found between age at diagnosis with stage of cancer and cancer type. Differences in probability of ST by cancer stage converged as age increased. In multivariable analysis, adjusting for covariates, patients with MM had the highest odds and lung cancer the lowest odds to receive ST. The impact of comorbidity and polypharmacy did not differ meaningfully with increasing age.

Discussion: Increased age, polypharmacy, and comorbidity were each independently associated with decreased receipt of ST in people with advanced cancers. The impact of comorbidity and polypharmacy did not differ meaningfully with increasing age, while age meaningfully interacted with stage and cancer type.

Keywords: Chemotherapy; Decision-making; Geriatric oncology; Real world evidence; Treatment disparities.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Comorbidity
Humans
Lung Neoplasms* / drug therapy
Lung Neoplasms* / epidemiology
Male
Neoplasm Staging
Polypharmacy*
Retrospective Studies