Association of cancer diagnosis with disability status among older survivors of colorectal cancer: a population-based retrospective cohort study

Shiming Zhang; Lin-Na Chou; Michael D Swartz; Hemalkumar B Mehta; James S Goodwin; Yong-Fang Kuo; Sharon Hermes Giordano; Carole A Tucker; Karen M Basen-Engquist; Elizabeth J Lyons; Brian Downer; Susan K Peterson; Tru Cao; Maria C Swartz

doi:10.3389/fonc.2024.1283252

Association of cancer diagnosis with disability status among older survivors of colorectal cancer: a population-based retrospective cohort study

Front Oncol. 2024 Mar 15:14:1283252. doi: 10.3389/fonc.2024.1283252. eCollection 2024.

Authors

Affiliations

¹ Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States.
² Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
³ Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX, United States.
⁴ Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
⁵ Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, United States.
⁶ Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
⁷ Department of Physical Therapy, The University of Texas Medical Branch, Galveston, TX, United States.
⁸ Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
⁹ Department of Nutrition, Metabolism and Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX, United States.
¹⁰ Department of Population Health and Health Disparities, The University of Texas Medical Branch, Galveston, TX, United States.
¹¹ Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.

Abstract

Background: Older cancer survivors likely experience physical function limitations due to cancer and its treatments, leading to disability and early mortality. Existing studies have focused on factors associated with surgical complications and mortality risk rather than factors associated with the development of poor disability status (DS), a proxy measure of poor performance status, in cancer survivors. We aimed to identify factors associated with the development of poor DS among older survivors of colorectal cancer (CRC) and compare poor DS rates to an age-sex-matched, non-cancer cohort.

Methods: This retrospective cohort study utilized administrative data from the Texas Cancer Registry Medicare-linked database. The study cohort consisted of 13,229 survivors of CRC diagnosed between 2005 and 2013 and an age-sex-matched, non-cancer cohort of 13,225 beneficiaries. The primary outcome was poor DS, determined by Davidoff's method, using predictors from 12 months of Medicare claims after cancer diagnosis. Multivariable Cox proportional hazards regression was used to identify risk factors associated with the development of poor DS.

Results: Among the survivors of CRC, 97% were 65 years or older. After a 9-year follow-up, 54% of survivors of CRC developed poor DS. Significant factors associated with future poor DS included: age at diagnosis (hazard ratio [HR] = 3.50 for >80 years old), female sex (HR = 1.50), race/ethnicity (HR = 1.34 for Hispanic and 1.21 for Black), stage at diagnosis (HR = 2.26 for distant metastasis), comorbidity index (HR = 2.18 for >1), and radiation therapy (HR = 1.21). Having cancer (HR = 1.07) was significantly associated with developing poor DS in the pooled cohorts; age and race/ethnicity were also significant factors.

Conclusions: Our findings suggest that a CRC diagnosis is independently associated with a small increase in the risk of developing poor DS after accounting for other known factors. The study identified risk factors for developing poor DS in CRC survivors, including Hispanic and Black race/ethnicity, age, sex, histologic stage, and comorbidities. These findings underscore the importance of consistent physical function assessments, particularly among subsets of older survivors of CRC who are at higher risk of disability, to prevent developing poor DS.

Keywords: aged; cancer survivors; colorectal neoplasms; mobility limitations; risk factors.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Cancer Prevention Research Institute of Texas (RP140020 and RP170668). Additional salary support was provided by the UTHealth Houston-Cancer Prevention Research Institute of Texas Innovation for Cancer Prevention Research Pre-Doctoral Fellowship (RP210042); the National Institute on Disability, Independent Living, and Rehabilitation Research (90AR5009); a Mentored Research Scholar Grant in Applied and Clinical Research (MRSG-14-165-01-CPPB) from the American Cancer Society; the American Heart Association (13BGIA17110021, 16PRE27090012); the National Institute of Child Health and Human Development (National Center for Medical Rehabilitation Research), the National Institute for Neurological Disorders and Stroke, and the National Institute of Biomedical Imaging and Bioengineering (P2CHD065702); the Claude D. Pepper Older Americans Independence Center (P30AG024832); the National Institute on Aging (1R01AG064092, K01AG070329); the Center for Energy Balance in Cancer Prevention and Survivorship, Duncan Family Institute for Cancer Prevention and Risk Assessment; the Susan G. Komen (Komen SAC150061); and MD Anderson’s Cancer Center Support Grant (CA016672).